title: External validation of a web-based prognostic tool for predicting survival for patients in hospice care.
abstract: Prognostat is an interactive Web-based prognostic tool for estimating hospice patient survival based on a patient's Palliative Performance Scale (PPS) score, age, gender, and cancer status. The tool was developed using data from 5,893 palliative care patients, which was collected at the Victoria Hospice in Victoria, British Columbia, Canada, beginning in 1994. This study externally validates Prognostat with a retrospective cohort of 590 hospice patients at LifePath Hospice and Palliative Care in Florida, USA. The criteria used to evaluate the prognostic performance were the Brier score, area under the receiver operating curve, discrimination slope, and Hosmer-Lemeshow goodness-of-fit test. Though the Kaplan-Meier curves show each PPS level to be distinct and significantly different, the findings reveal low agreement between observed survival in our cohort of patients and survival predicted by the prognostic tool. Before developing a new prognostic model, researchers are encouraged to update survival estimates obtained using Prognostat with the information from their cohort of patients. If it is to be useful to patients and clinicians, Prognostat needs to explicitly report patient risk scores and estimates of baseline survival.
authors.affiliation: Center for Evidence-Based Medicine and Health Outcomes Research, Morsani College of Medicine, University of South Florida, 3515 E. Fletcher Avenue, MDT1200, Mail Code MDC27, Tampa, Florida 33612, USA. bmiladin@health.usf.edu
authors.forename: Branko
authors.initials: B
authors.lastname: Miladinovic
authors.affiliation: Center for Evidence-Based Medicine and Health Outcomes Research, University of South Florida, Tampa, Florida, USA.
authors.forename: Rahul
authors.initials: R
authors.lastname: Mhaskar
authors.affiliation: Center for Evidence-Based Medicine and Health Outcomes Research, University of South Florida, Tampa, Florida, USA.
authors.forename: Ambuj
authors.initials: A
authors.lastname: Kumar
authors.affiliation: HPC Healthcare, Temple Terrace, Florida, USA.
authors.forename: Sehwan
authors.initials: S
authors.lastname: Kim
authors.affiliation: HPC Healthcare, Temple Terrace, Florida, USA.
authors.forename: Ronald
authors.initials: R
authors.lastname: Schonwetter
authors.affiliation: HPC Healthcare, Temple Terrace, Florida, USA.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Djulbegovic
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003661:Decision Support Techniques; D005260:Female; D005431:Florida; D017051:Hospice Care; D006801:Humans; D020407:Internet; D053208:Kaplan-Meier Estimate; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies