title: Independent validation of the modified prognosis palliative care study predictor models in three palliative care settings.
abstract: BACKGROUND
  Accurate prognostic information in palliative care settings is needed for patients to make decisions and set goals and priorities. The Prognosis Palliative Care Study (PiPS) predictor models were presented in 2011, but have not yet been fully validated by other research teams.
  
  
  OBJECTIVE
  The primary aim of this study is to examine the accuracy and to validate the modified PiPS (using physician-proxy ratings of mental status instead of patient interviews) in three palliative care settings, namely palliative care units, hospital-based palliative care teams, and home-based palliative care services.
  
  
  METHODS
  This multicenter prospective cohort study was conducted in 58 palliative care services including 16 palliative care units, 19 hospital-based palliative care teams, and 23 home-based palliative care services in Japan from September 2012 through April 2014.
  
  
  RESULTS
  A total of 2426 subjects were recruited. For reasons including lack of followup and missing variables (primarily blood examination data), we obtained analyzable data from 2212 and 1257 patients for the modified PiPS-A and PiPS-B, respectively. In all palliative care settings, both the modified PiPS-A and PiPS-B identified three risk groups with different survival rates (P<0.001). The absolute agreement ranged from 56% to 60% in the PiPS-A model and 60% to 62% in the PiPS-B model.
  
  
  CONCLUSIONS
  The modified PiPS was successfully validated and can be useful in palliative care units, hospital-based palliative care teams, and home-based palliative care services.
authors.affiliation: Department of Palliative Care, Saito Yukoukai Hospital, Ibaragi, Osaka, Japan. Electronic address: baba@saito-yukoukai-hp.jp.
authors.forename: Mika
authors.initials: M
authors.lastname: Baba
authors.affiliation: Department of Palliative Medicine, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan.
authors.forename: Isseki
authors.initials: I
authors.lastname: Maeda
authors.affiliation: Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu City, Shizuoka, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Morita
authors.affiliation: Tsukuba Medical Center Foundation, Tsukuba, Ibaraki, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Hisanaga
authors.affiliation: Palliative Care Department, Okayama Saiseikai General Hospital, Okayama City, Okayama, Japan.
authors.forename: Tatsuhiko
authors.initials: T
authors.lastname: Ishihara
authors.affiliation: Matsue City Hospital, Matsue City, Shimane, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Iwashita
authors.affiliation: Department of Palliative Care Unit, JCHO Tokyo Shinjuku Medical Center, Shinjuku, Tokyo, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Kaneishi
authors.affiliation: Aozora Clinic, Matsudo-city, Chiba, Japan.
authors.forename: Shohei
authors.initials: S
authors.lastname: Kawagoe
authors.affiliation: Department of Palliative Medicine, Wakayama Medical University Hospital Oncology Center, Kimiidera, Wakayama, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Kuriyama
authors.affiliation: Department of Palliative Care, Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, Bunkyo-ku, Tokyo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Maeda
authors.affiliation: Gratia Hospital Hospice, Mino, Osaka, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Mori
authors.affiliation: Department of Palliative Medicine, Graduate School of Medicine, Tohoku University, Sendai, Miyagi, Japan.
authors.forename: Nobuhisa
authors.initials: N
authors.lastname: Nakajima
authors.affiliation: Kawasaki Comprehensive Care Center, Kawasaki Municipal Ida Hospital, Nakahara-ku, Kanagawa, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Nishi
authors.affiliation: Department of Palliative Care, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Sakurai
authors.affiliation: Department of Palliative Care, Aichi Cancer Center Hospital, Chikusa-ku, Nagoya, Japan.
authors.forename: Satofumi
authors.initials: S
authors.lastname: Shimoyama
authors.affiliation: Shinjo Clinic, Kobe, Hyogo, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Shinjo
authors.affiliation: Iryouhoujinn Takumikai Osaka Kita Homecare Clinic, Osaka City, Osaka, Japan.
authors.forename: Hiroto
authors.initials: H
authors.lastname: Shirayama
authors.affiliation: Department of Gastrointestinal and Hepatobiliary-Pancreatic Surgery, Nippon Medical School, Bunkyo-ku, Tokyo, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yamada
authors.affiliation: Division of Palliative Medicine, Shizuoka Cancer Center Hospital, Suntou-gun, Shizuoka, Japan.
authors.forename: Shigeki
authors.initials: S
authors.lastname: Ono
authors.affiliation: Megumi Zaitaku Clinic, Yokohama-shi, Kanagawa, Japan.
authors.forename: Taketoshi
authors.initials: T
authors.lastname: Ozawa
authors.affiliation: Department of Palliative Medicine, Saku Central Hospital Advanced Care Center, Saku-shi, Nagano, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Yamamoto
authors.affiliation: Department of Multidisciplinary Cancer Treatment, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Tsuneto
mesh_terms: D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D016638:Critical Illness / Q000401:mortality* / Q000628:therapy*; D005260:Female; D006699:Home Care Services / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D010166:Palliative Care / Q000706:statistics & numerical data*; D015995:Prevalence; D011379:Prognosis; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Prognosis palliative care study predictor models; modified; palliative setting; prognostic score; validation study