The Accuracy of Probabilistic Versus Temporal Clinician Prediction of Survival for Patients with Advanced Cancer: A Preliminary Report
- 30 September 2011
- journal article
- research article
- Published by Oxford University Press (OUP) in The Oncologist
- Vol. 16 (11), 1642-1648
- https://doi.org/10.1634/theoncologist.2011-0173
Abstract
Clinicians have limited accuracy in the prediction of patient survival. We assessed the accuracy of probabilistic clinician prediction of survival (CPS) and temporal CPS for advanced cancer patients admitted to our acute palliative care unit, and identified factors associated with CPS accuracy. Eight physicians and 20 nurses provided their estimation of survival on admission by (a) the temporal approach, “What is the approximate survival for this patient (in days)?” and (b) the probabilistic approach, “What is the approximate probability that this patient will be alive (0%–100%)?” for ≥24 hours, 48 hours, 1 week, 2 weeks, 1 month, 3 months, and 6 months. We also collected patient and clinician demographics. Among 151 patients, the median age was 58 years, 95 (63%) were female, and 138 (81%) had solid tumors. The median overall survival time was 12 days. The median temporal CPS was 14 days for physicians and 20 days for nurses. Physicians were more accurate than nurses. A higher accuracy of temporal physician CPS was associated with older patient age. Probabilistic CPS was significantly more accurate than temporal CPS for both physicians and nurses, although this analysis was limited by the different criteria for determining accuracy. With the probabilistic approach, nurses were significantly more accurate at predicting survival at 24 hours and 48 hours, whereas physicians were significantly more accurate at predicting survival at 6 months. The probabilistic approach was associated with high accuracy and has practical implications.Keywords
Funding Information
- National Institutes of Health (RO1NR010162-01A1, RO1CA122292-01, RO1CA124481-01)
- MD Anderson Cancer Center
This publication has 26 references indexed in Scilit:
- Prognostic Significance of the “Surprise” Question in Cancer PatientsJournal of Palliative Medicine, 2010
- How Accurate Are Physicians in the Prediction of Patient Survival in Advanced Lung Cancer?The Oncologist, 2010
- Antineoplastic therapy use in patients with advanced cancer admitted to an acute palliative care unit at a comprehensive cancer centerCancer, 2010
- Discharge Outcomes and Survival of Patients with Advanced Cancer Admitted to an Acute Palliative Care Unit at a Comprehensive Cancer CenterJournal of Palliative Medicine, 2010
- Goals of Care and End-of-Life Decision Making for Hospitalized Patients at a Canadian Tertiary Care Cancer CenterJournal of Pain and Symptom Management, 2009
- Evaluation and comparison of two prognostic scores and the physicians’ estimate of survival in terminally ill patientsSupportive Care in Cancer, 2009
- Offering a prognosis in lung cancer: when is a team of experts an expert team?Journal of Epidemiology and Community Health, 2007
- Terminal cancer: duration and prediction of survival timeEuropean Journal Of Cancer, 2000
- Extent and determinants of error in doctors' prognoses in terminally ill patients: prospective cohort study Commentary: Why do doctors overestimate? Commentary: Prognoses should be based on proved indices not intuitionBMJ, 2000
- A New Palliative Prognostic ScoreJournal of Pain and Symptom Management, 1999