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Int J Palliat Nurs. 2016 Aug;22(8):380-7. doi: 10.12968/ijpn.2016.22.8.380.

Clinical prediction survival of advanced cancer patients by palliative care: a multi-site study.

Author information

1
Associate Clinical Professor, Division of Palliative Care Medicine, Department of Oncology, University of Alberta Hospital, Edmonton, Canada.
2
Assistant Clinical Professor, Medical Oncology, Cross Cancer Institute, Edmonton, Canada.
3
Associate Clinical Professor, Department of Oncology, Royal Alexandra Hospital, Edmonton, Canada.
4
Associate Clinical Professor, Department of Oncology, University of Alberta Hospitals, Edmonton, Canada.
5
Assistant Professor, Covenant Health Palliative Institute Palliative Care Medicine, Edmonton, Canada.
6
Professor, University of Victoria, Victoria, British Columbia, Canada.
7
Clinical Professor, Department of Oncology, Grey Nuns Hospital, Edmonton.
8
Associate Clinical Professor, Department of Oncology, Edmonton, Canada.
9
Database Manager, Grey Nuns Hospital, Edmonton, Canada.
10
Biostatistician, University of Victoria, Victoria, British Columbia, Canada.
11
Clinical Practice Leader, Pharmacy Department, University of Alberta Hospitals, Edmonton, Canada.

Abstract

AIMS:

This study examined (1) accuracy of clinician prediction of survival (CPS) by palliative practitioners on first assessment with the use of standardised palliative tools, (2) factors affecting accuracy, (3) potential impact on clinical care.

METHODS:

A multi-site prospective study (n=1530) was used. CPS was divided into four time periods (<=2wks, >2 to 6wks, >6 to 12wks and >12wks). Multivariate analysis was assessed on six predictor variables.

RESULTS:

Overall, median survival of the sample was only 5 weeks. CPS category was accurate only 38.6% of the time, with 44.6% patients dying before the predicted time period. Of six candidate variables, on multivariate analysis only (i) the clinical time periods themselves and (ii) Palliative Performance Scale <=50 predicted for prognostic accuracy.

CONCLUSION:

CPS, even by palliative practitioners, remains overly optimistic with the existence of the horizon effect. This raises the question in that these individuals may have been potentially overtreated.

KEYWORDS:

Accuracy; Palliative; Prognostication; Survival prediction

PMID:
27568777
DOI:
10.12968/ijpn.2016.22.8.380
[Indexed for MEDLINE]

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