Accuracy of prognosis estimates by four palliative care teams: a prospective cohort study

Irene J Higginson ¹ and Massimo Costantini ²

¹Dept. Palliative Care and Policy, Guy's, King's and St Thomas' School of Medicine, King's College London, Weston Education Centre, Cutcombe Road, Denmark Hill, London, SE5 9PJ, England

²Unit of Clinical Epidemiology and Trials, National Cancer Institute, L.go R. Benzi, 10 16132 Genova, Italy

author email corresponding author email

BMC Palliative Care 2002, 1:1doi:10.1186/1472-684X-1-1


Published:	4 March 2002

Abstract

Background

Prognosis estimates are used to access services, but are often inaccurate. This study aimed to determine the accuracy of giving a prognosis range.

Methods and measurements

A prospective cohort study in four multi-professional palliative care teams in England collected data on 275 consecutive cancer referrals who died. Prognosis estimates (minimum – maximum) at referral, patient characteristics, were recorded by staff, and later compared with actual survival.

Results

Minimum survival estimates ranged <1 to 364 days, maximum 7 – 686 days. Mean patient survival was 71 days (range 1 – 734). In 42% the estimate was accurate, in 36% it was over optimistic and in 22% over pessimistic. When the minimum estimate was less than 14 days accuracy increased to 70%. Accuracy was related, in multivariate analysis, to palliative care team and (of borderline significance) patient age.

Conclusions

Offering a prognosis range has higher levels of accuracy (about double) than traditional estimates, but is still very often inaccurate, except very close to death. Where possible clinicians should discuss scenarios with patients, rather than giving a prognosis range.