title: Multidisciplinary Prognostication Using the Palliative Prognostic Score in an Australian Cancer Center.
abstract: BACKGROUND
  Accurate prognostication is important in oncology and palliative care. A multidisciplinary approach to prognostication provides a novel approach, but its accuracy and application is poorly researched. In this study, we describe and analyze our experience of multidisciplinary prognostication in palliative care patients with cancer.
  
  
  OBJECTIVE
  To assess our accuracy of prognostication using multidisciplinary team prediction of survival (MTPS) alone and within the Palliative Prognostic (PaP) Score.
  
  
  METHODS
  This retrospective study included all new patients referred to a palliative care consultation service in a tertiary cancer center between January 2010 and December 2011. Initial assessment data for 421 inpatients and 223 outpatients were analyzed according to inpatient and outpatient groups to evaluate the accuracy of prognostication using MTPS alone and within the PaP score (MTPS-PaP) and their correlation with overall survival.
  
  
  RESULTS
  Inpatients with MTPS-PaP group A, B, and C had a median survival of 10.9, 3.4, and 0.7 weeks, respectively, and a 30-day survival probability of 81%, 40%, and 10%, respectively. Outpatients with MTPS-PaP group A and B had a median survival of 17.3 and 5.1 weeks, respectively, and a 30-day survival probability of 94% and 50%, respectively. MTPS overestimated survival by a factor of 1.5 for inpatients and 1.2 for outpatients. The MTPS-PaP score correlated better than MTPS alone with overall survival.
  
  
  CONCLUSIONS
  This study suggests that a multidisciplinary team approach to prognostication within routine clinical practice is possible and may substitute for single clinician prediction of survival within the PaP score without detracting from its accuracy. Multidisciplinary team prognostication can assist treating teams to recognize and articulate prognosis, facilitate treatment decisions, and plan end-of-life care appropriately. PaP was less useful in the outpatient setting, given the longer survival interval of the outpatient palliative care patient group.
authors: Department of Pain & Palliative Care, Peter MacCallum Cancer Centre, VIC, Australia ; Austin Health, Department of Palliative Care, Studley Road, Heidelberg, VIC, Australia.
authors: Ruwani
authors: R
authors: Mendis
authors: Department of Pain & Palliative Care, Peter MacCallum Cancer Centre, VIC, Australia ; Eastern Health Clinical School, Monash University, Box Hill, VIC, Australia.
authors: Wee-Kheng
authors: WK
authors: Soo
authors: Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, VIC, Australia.
authors: Diana
authors: D
authors: Zannino
authors: Department of Palliative Care, Cabrini Health, Prahran, VIC, Australia.
authors: Natasha
authors: N
authors: Michael
authors: Department of Pain & Palliative Care, Peter MacCallum Cancer Centre, VIC, Australia.
authors: Odette
authors: O
authors: Spruyt
keywords: PaP score; cancer; clinician prediction of survival (CPS); inpatients; multidisciplinary team; multidisciplinary team prediction of survival (MTPS); outpatients; palliative care; prognostication