title: Validation of a palliative prognostic index to predict life expectancy for terminally ill cancer patients in a hospice consultation setting in Taiwan.
abstract: BACKGROUND
  The aim of our study was to assess the practical utility of the palliative prognostic index (PPI) as a prognostic tool used by nurse specialists in a hospice consultation setting in Taiwan.
  
  
  METHODS
  In total, 623 terminal cancer patients under hospice consultation care from one medical center in northern Taiwan were enrolled between January 1 and June 30, 2011. PPI was assessed by a nurse specialist at first hospice consultation and patients categorized into groups by prognosis (good, intermediate, poor). Patient survival was analyzed retrospectively to determine significance of between-group differences.
  
  
  RESULTS
  By PPI sum score, 37.2% of patients were in the good prognosis group, 18% in the intermediate prognosis group and 44.8% in the poor prognosis group. The death rates were 56%, 81.2% and 89.6% and median survivals were 76, 18 and 7 days, respectively. The hazard ratio was 0.19 (95% confidence interval [CI] 0.10-0.24, p<0.001) for the poor versus good prognosis group and 0.54 (95% CI 0.43-0.69, p<0.001) for the poor versus intermediate prognosis group. The sensitivity and specificity for the poor prognosis group was 66% and 71%; the positive predictive value and negative predictive value were 81% and 52%, respectively, to predict patient death within 21 days (area under the curve of the receiver operating characteristic was 0.68).
  
  
  CONCLUSIONS
  Assessment by PPI can accurately predict survival of terminal cancer patients receiving hospice consultation care. PPI is a simple tool and can be administered by nurse members of hospice consultation teams.
authors.affiliation: Division of Hematology-Oncology, Chang Gung Memorial Hospital, and School of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Wei-Hong
authors.initials: WH
authors.lastname: Cheng
authors.forename: Chen-Yi
authors.initials: CY
authors.lastname: Kao
authors.forename: Yu-Shin
authors.initials: YS
authors.lastname: Hung
authors.forename: Po-Jung
authors.initials: PJ
authors.lastname: Su
authors.forename: Chia-Hsun
authors.initials: CH
authors.lastname: Hsieh
authors.forename: Jen-Shi
authors.initials: JS
authors.lastname: Chen
authors.forename: Hung-Ming
authors.initials: HM
authors.lastname: Wang
authors.forename: Wen-Chi
authors.initials: WC
authors.lastname: Chou
mesh_terms: D000368:Aged; D005260:Female; D017051:Hospice Care; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality*; D010166:Palliative Care; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013624:Taiwan; D013727:Terminal Care; D019452:Terminally Ill / Q000706:statistics & numerical data*