Annals of palliative medicine · 2026
Multidisciplinary clinical prediction of survival of patients attending Palliative Radiation Oncology and Palliative Care clinics: a prospective cohort study.
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Shahzad Hassan, Baracos Vickie E, Debenham Brock, Watanabe Sharon M, Huot Ann, Fairchild Alysa
Аннотация
BACKGROUND: Clinical prediction of survival (CPS) in Oncology has rarely been compared among different health care disciplines. Our aim was to evaluate the prognostication ability of multidisciplinary team (MDT) members experienced in providing specialist Palliative Care (PC) and palliative radiotherapy (PRT).
METHODS: We conducted a prospective cohort study in a tertiary cancer center serving the northern half of the Canadian province of Alberta. After usual direct clinical assessment of consecutive patients with any primary histology, survival predictions were independently made by each clinician, and factors influencing predictions were collected from each assessor. CPS was considered correct if within 30 days or 30% of actual survival (AS).
RESULTS: Clinicians assessed 980 patients [2010-2014], of whom 944 have died (96.3%) with median AS of 122 days [95% confidence interval (CI): 116-128]. Median Palliative Performance Scale was 62±15. Eleven disciplines, including physicians, nurses, radiation therapists, other allied health professionals and trainees made a total of 2,776 predictions during 1,130 clinic visits. Overall, CPS was significantly longer than AS. On average, 30.7% of predictions were correct (range 20.1-40.6% across disciplines). Survival was more often overpredicted (47.1%) than underpredicted (22.2%). The median number of days overpredicted varied significantly by discipline, from 47 [39-55] to 161 [135-187] days. Differential accuracy persisted after adjustment for primary tumor site, gender and duration of AS. Factors underpinning CPS also varied by discipline.
CONCLUSIONS: Although all disciplines had a propensity to overpredict survival, each did so with differing accuracy, based on different clinical parameters.
METHODS: We conducted a prospective cohort study in a tertiary cancer center serving the northern half of the Canadian province of Alberta. After usual direct clinical assessment of consecutive patients with any primary histology, survival predictions were independently made by each clinician, and factors influencing predictions were collected from each assessor. CPS was considered correct if within 30 days or 30% of actual survival (AS).
RESULTS: Clinicians assessed 980 patients [2010-2014], of whom 944 have died (96.3%) with median AS of 122 days [95% confidence interval (CI): 116-128]. Median Palliative Performance Scale was 62±15. Eleven disciplines, including physicians, nurses, radiation therapists, other allied health professionals and trainees made a total of 2,776 predictions during 1,130 clinic visits. Overall, CPS was significantly longer than AS. On average, 30.7% of predictions were correct (range 20.1-40.6% across disciplines). Survival was more often overpredicted (47.1%) than underpredicted (22.2%). The median number of days overpredicted varied significantly by discipline, from 47 [39-55] to 161 [135-187] days. Differential accuracy persisted after adjustment for primary tumor site, gender and duration of AS. Factors underpinning CPS also varied by discipline.
CONCLUSIONS: Although all disciplines had a propensity to overpredict survival, each did so with differing accuracy, based on different clinical parameters.