How palliative care professionals deal with predicting life expectancy at the end of life: predictors and accuracy

• Published in: Supportive care in cancer Vol. 29; no. 4; pp. 2093 - 2103
• Main Authors: Mandelli, Sara, Riva, Emma, Tettamanti, Mauro, Lucca, Ugo, Lombardi, Davide, Miolo, Gianmaria, Spazzapan, Simon, Marson, Rita
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.04.2021; Springer; Springer Nature B.V
• Subjects: Accuracy; Aged; Cancer; Data Accuracy; Death; Female; Health aspects; Hospices (Terminal care); Humans; Life expectancy; Life Expectancy - trends; Male; Medical care; Medical prognosis; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Nurses; Nursing; Nursing Research; Observational studies; Oncology; Original Article; Pain Medicine; Palliative care; Palliative Care - methods; Palliative treatment; Physicians; Prospective Studies; Quality management; Rehabilitation Medicine; Terminal illnesses; Terminally ill; Survival prediction; Observational study; Accuracy; Hospice
• ISSN: 0941-4355; 1433-7339; 1433-7339
• DOI: 10.1007/s00520-020-05720-6

Purpose To assess the accuracy of hospice staff in predicting survival of subjects admitted to hospice, exploring the factors considered most helpful by the hospice staff to accurately predict survival. Methods Five physicians and 11 nurses were asked to predict survival at admission of 827 patients. Actual and predicted survival times were divided into ≤ 1 week, 2–3 weeks, 4–8 weeks, and ≥ 2 months and the accuracy of the estimates was calculated. The staff members were each asked to score 17 clinical variables that guided them in predicting survival and we analyzed how these variables impacted the accuracy. Results Physicians’ and nurses’ accuracy of survival of the patients was 46% and 40% respectively. Survival was underestimated in 20% and 12% and overestimated in 34% and 48% of subjects. Both physicians and nurses considered metastases, comorbidities, dyspnea, disability, tumor site, neurological symptoms, and confusion very important in predicting patients’ survival with nurses assigning more importance to intestinal symptoms and pain too. All these factors, with the addition of cough and/or bronchial secretions, were associated with physicians’ greater accuracy. In the multivariable models, intestinal symptoms and confusion continued to be associated with greater predictive accuracy. No factors appreciably raised nurses’ accuracy. Conclusions Some clinical symptoms rated as relevant by the hospice staff could be important for predicting survival. However, only intestinal symptoms and confusion significantly improved the accuracy of physicians’ predictions, despite the high prevalence of overestimated survival.