How palliative care professionals deal with predicting life expectancy at the end of life: predictors and accuracy
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ORIGINAL ARTICLE
How palliative care professionals deal with predicting life expectancy at the end of life: predictors and accuracy Sara Mandelli 1 & Emma Riva 1 & Mauro Tettamanti 1 & Ugo Lucca 1 & Davide Lombardi 2 & Gianmaria Miolo 2 & Simon Spazzapan 2 & Rita Marson 2 & on behalf of the Via di Natale Hospice investigators Received: 17 April 2020 / Accepted: 26 August 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To assess the accuracy of hospice staff in predicting survival of subjects admitted to hospice, exploring the factors considered most helpful by the hospice staff to accurately predict survival. Methods Five physicians and 11 nurses were asked to predict survival at admission of 827 patients. Actual and predicted survival times were divided into ≤ 1 week, 2–3 weeks, 4–8 weeks, and ≥ 2 months and the accuracy of the estimates was calculated. The staff members were each asked to score 17 clinical variables that guided them in predicting survival and we analyzed how these variables impacted the accuracy. Results Physicians’ and nurses’ accuracy of survival of the patients was 46% and 40% respectively. Survival was underestimated in 20% and 12% and overestimated in 34% and 48% of subjects. Both physicians and nurses considered metastases, comorbidities, dyspnea, disability, tumor site, neurological symptoms, and confusion very important in predicting patients’ survival with nurses assigning more importance to intestinal symptoms and pain too. All these factors, with the addition of cough and/or bronchial secretions, were associated with physicians’ greater accuracy. In the multivariable models, intestinal symptoms and confusion continued to be associated with greater predictive accuracy. No factors appreciably raised nurses’ accuracy. Conclusions Some clinical symptoms rated as relevant by the hospice staff could be important for predicting survival. However, only intestinal symptoms and confusion significantly improved the accuracy of physicians’ predictions, despite the high prevalence of overestimated survival. Keywords Hospice . Observational study . Survival prediction . Accuracy . Terminally ill
Introduction Predicting life expectancy is one of the many difficult tasks that physicians and nurses face with terminally ill cancer patients. However, accurate prediction is important for subjects, their caregivers, and healthcare providers to decide on appropriate treatment options and timing for referral to palliative Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00520-020-05720-6) contains supplementary material, which is available to authorized users. * Sara Mandelli [email protected] 1
Laboratory of Geriatric Neuropsychiatry, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156 Milan, Italy
2
Via di Natale Hospice, Aviano, Pordenone, Italy
care services such as a hospice or home-based palliative care. Clinical predictions of survival for subjects with advanced cancer are ofte
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