Incorporating routine survival prediction in a U.S. hospital-based palliative care service.
BACKGROUND
Prognostication is a core component of palliative care consultation. We sought to incorporate predicted survival into the routine practice of our hospital-based palliative care team.


METHODS
The predicted survival was determined by the physician and/or nurse at the time of initial palliative care consultation using categories that parallel the rough time frames often shared with patients and used in planning care: (1) ≤3 days, (2) 4 days to 1 month, (3) >1 month to 6 months, (4) >6 months. One year later, survival status at 6 months was determined using death certificates, the Social Security online database, and other methods.


RESULTS
Over 1 year, complete data were obtained for 429 of 450 (95.3%) consecutive new patient consults. Patients' mean and median age was 63, 48.5% had cancer, 83% were Caucasian, and 50% were female. For the 283 patients who were discharged alive, median survival was 18 days and 58 patients were still alive after 6 months. Fifty-eight percent of patients were assigned to the correct survival category, whereas 27% of prognoses were too optimistic and 16% were too pessimistic. In logistic regression analysis, predicted survivals of ≤3 days were much more likely to be accurate than longer predictions.


CONCLUSIONS
The team recorded a predicted survival in 95% of new patient consults. Fifty-eight percent accuracy is in line with prior literature. Routinely incorporating survival prediction into palliative care consultation raised a number of questions. What decisions were made based on the 42% incorrect prognoses? Did these decisions negatively affect care? Survival prediction accuracy has potential as a quality measure for hospital-based palliative care programs, however to be truly useful it needs to be shown to be "improveable" and the downstream effects of predictions need to be better understood.
Division of Hematology and Medical Oncology, Oregon Health & Science University, Portland, Oregon 97239, USA. frommee@ohsu.edu
Erik K
EK
Fromme
Mary Denise
MD
Smith
Paul B
PB
Bascom
Tawni
T
Kenworthy-Heinige
Karen S
KS
Lyons
Susan W
SW
Tolle
D005260:Female; D005544:Forecasting; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D009922:Oregon; D010166:Palliative Care; D011379:Prognosis; D016019:Survival Analysis; D014481:United States