title: The accuracy of probabilistic versus temporal clinician prediction of survival for patients with advanced cancer: a preliminary report.
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.
authors: Department of Palliative Care & Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA. dhui@mdanderson.org
authors: David
authors: D
authors: Hui
authors: Kelly
authors: K
authors: Kilgore
authors: Linh
authors: L
authors: Nguyen
authors: Stacy
authors: S
authors: Hall
authors: Julieta
authors: J
authors: Fajardo
authors: Tonye P
authors: TP
authors: Cox-Miller
authors: Shana L
authors: SL
authors: Palla
authors: Wadih
authors: W
authors: Rhondali
authors: Jung Hun
authors: JH
authors: Kang
authors: Sun Hyun
authors: SH
authors: Kim
authors: Egidio
authors: E
authors: Del Fabbro
authors: Donna S
authors: DS
authors: Zhukovsky
authors: Suresh
authors: S
authors: Reddy
authors: Ahmed
authors: A
authors: Elsayem
authors: Shalini
authors: S
authors: Dalal
authors: Rony
authors: R
authors: Dev
authors: Paul
authors: P
authors: Walker
authors: Sriram
authors: S
authors: Yennu
authors: Akhila
authors: A
authors: Reddy
authors: Eduardo
authors: E
authors: Bruera
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009369:Neoplasms / Q000175:diagnosis* / Q000401:mortality; D010166:Palliative Care; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D016019:Survival Analysis; D013781:Texas / Q000453:epidemiology; D055815:Young Adult