The accuracy of probabilistic versus temporal clinician prediction of survival for patients with advanced cancer: A preliminary report

David Hui, Kelly Kilgore, Linh Nguyen, Stacy Hall, Julieta Fajardo, Tonye P. Cox-Miller, Shana L. Palla, Wadih Rhondali, Jung Hun Kang, Sun Hyun Kim, Egidio del Fabbro, Donna S. Zhukovsky, Suresh Reddy, Ahmed Elsayem, Shalini Dalal, Rony Dev, Paul Walker, Sriram Yennu, Akhila Reddy, Eduardo Bruera

Research output: Contribution to journalArticlepeer-review

55 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)1642-1648
Number of pages7
JournalOncologist
Volume16
Issue number11
DOIs
StatePublished - 2011
Externally publishedYes

Keywords

  • Neoplasms
  • Palliative care
  • Probability
  • Prognosis

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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