Skip to main content

Advertisement

SpringerLink
Log in

How palliative care professionals deal with predicting life expectancy at the end of life: predictors and accuracy

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. White N, Reid F, Harris A, Harries P, Stone P (2016) A systematic review of predictions of survival in palliative care: how accurate are clinicians and who are the experts? PLoS One 11(8):e0161407

    PubMed  PubMed Central  Google Scholar 

  2. Cheon S, Agarwal A, Popovic M, Milakovic M, Lam M, Fu W, Di Giovanni J, Lam H, Lechner B, Pulenzas N, Chow R, Chow E (2016) The accuracy of clinicians’ prediction of survival in advanced cancer: a review. Ann Palliat Med 5(1):22–29

    PubMed  Google Scholar 

  3. Zhou M, Holden L, Lao N, Lam H, Zeng L, Chow E (2013) Accuracy of clinicians’ prediction of survival and prognostic factors indicative of survival: a systematic review. Hong Kong J Radiol 16:168–182

    Google Scholar 

  4. Christakis N, Iwashyna TJ (1998) Attitude and self-reported practice regarding prognostication in a national sample of internists. Arch Intern Med 158:2389–2395

    CAS  PubMed  Google Scholar 

  5. Christakis N, Lamont E (2000) Extent and determinants of error in doctors’ prognoses in terminally ill patients: prospective cohort study. BMJ 320(7233):469–472

    CAS  PubMed  PubMed Central  Google Scholar 

  6. Fairchild A, Debenham B, Danielson B, Huang F (2014) Comparative multidisciplinary prediction of survival in patients with advanced cancer. Support Care Cancer 22:611–617

    CAS  PubMed  Google Scholar 

  7. Higginson IJ, Costantini M (2002) Accuracy of prognosis estimates by four palliative care teams: a prospective cohort study. BMC Palliat Care 1(1):1

    PubMed  PubMed Central  Google Scholar 

  8. Hui D, Kilgore K, Nguyen L, Hall S, Fajardo J, Cox-Miller TP, Palla SL, Rhondall W, Kang HJ, Kim SH, Del Fabbro E, Zhukovsky DS, Reddy S, Elsayem A, Dalal S, Dev R, Walker P, Yemmu S, Reddy A, Bruera E (2011) The accuracy of probabilistic versus temporal clinician prediction of survival for patients with advanced cancer: a preliminary report. Oncologist 16(11):1642–1648

    PubMed  PubMed Central  Google Scholar 

  9. Kao SCH, Butow P, Bray V, Clarke SJ, Vardy J (2011) Patient and oncologist estimates of survival in advanced cancer patients. Psychooncology 20(2):213–218

    PubMed  Google Scholar 

  10. Selby D, Chakraborty A, Lilien T, Stacey E, Zhang L, Myers J (2011) Clinician accuracy when estimating survival duration: the role of the patient’s performance status and time-based prognostic categories. J Pain Symptom Manag 42(4):578–588

    Google Scholar 

  11. Taniyama TK, Hashimoto K, Katsumata N, Hirakawa A, Yonemori K, Yunokawa M, Shimizu C, Tamura K, Ando M, Fujiwara Y (2014) Can oncologists predict survival for patients with progressive disease after standard chemotherapies? Curr Oncol 2182:84–90

    Google Scholar 

  12. Thai V, Ghosh S, Tarum Y, Wolch G, Fassbender K, Lau F, DeKock I, Mirosseini M, Quan H, Yang J, Mayo PR (2016) Clinical prediction survival of advanced cancer patients by palliative care: a multi-site study. Int J Palliat Nurs 22(8):380–387

    PubMed  Google Scholar 

  13. Viganò A, Dorgan M, Bruera E, Suarez-Almazor (1999) The relative accuracy of the clinical estimation of the duration of life for patients with end of life cancer. Cancer 86:170–176

    PubMed  Google Scholar 

  14. Tseng YD, Krishnan MS, Sullivan AJ, Jones JA, Chow E, Balboni TA (2013) How radiation oncologists evaluate and incorporate life expectancy estimates into the treatment of palliative cancer patients: a survey-based study. Int J Radiat Oncol Biol Phys 87(3):471–478

    PubMed  PubMed Central  Google Scholar 

  15. Parmelee PA, Thuras PD, Katz IR, Lawton MP (1995) Validation of the cumulative illness rating scale in a geriatric residential population. J Am Geriatr Soc 43:130–137

    CAS  PubMed  Google Scholar 

  16. Mahoney FI, Barthel DW (1965) Functional evaluation: the Barthel index. Md State Med J 14:61–65

    CAS  PubMed  Google Scholar 

  17. Karnofsky DA, Burchenal JH (1949) The clinical evaluation of chemotherapeutic agents in cancer. In: MacLeod CM (Ed), Evaluation of chemotherapeutic agents. Columbia Univ Press. Page 196

  18. Inouye SK, Van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI (1990) Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med 113:941–948

    CAS  PubMed  Google Scholar 

  19. Cohen J (1960) A coefficient of agreement for nominal scales. Educ Psychol Meas 20:37–46

    Google Scholar 

  20. Addington-Hall JM, MacDonald AHR (1990) Can the Spitzer Quality of Life Index help to reduce prognostic uncertainty in terminal care? Br J Cancer 62:695–699

    CAS  PubMed  PubMed Central  Google Scholar 

  21. Barnes EA, Chow E, Tsao MN, Bradley MN, Doyle M, Li K, Lam K, Danjoux C (2010) Physician expectations of treatment outcomes for patients with brain metastases referred for whole brain radiotherapy. Int J Radiation Oncology Biol Phys 76(1):187–192

    Google Scholar 

  22. Chow E, Davis L, Panzarella T, Hayter C, Szumacher E, Loblaw A, Wong R, Danjoux C (2005) Accuracy of survival prediction by palliative radiation oncologists. Int J Radiat Oncol Bio Phys 61(3):870–873

    Google Scholar 

  23. Clement-Duchene C, Carnin C, Guillemin F, Martinet Y (2010) How accurate are physicians in prediction of patient survival in advanced lung cancer? Oncologist 15(7):782–789

    PubMed  PubMed Central  Google Scholar 

  24. Gripp S, Moeller S, Bolke E, Schmitt G, Matuschek C, Asgari S, Asgharzadeh F, Roth S, Budach W, Franz M, Willers R (2007) Survival prediction in terminally ill cancer patients by clinical estimates, laboratory tests, and self-rated anxiety and depression. J Clin Oncol 25:3313–3320

    PubMed  Google Scholar 

  25. Gwilliam B, Keeley V, Todd C, Roberts C, Gittins M, Kelly L, Barclay S, Stone P (2013) Prognosticating in patients with advanced cancer-observational study comparing the accuracy of clinicians’ and patients’ estimates of survival. Ann Oncol 24(2):482–488

    CAS  PubMed  Google Scholar 

  26. Hartsell WF, Desilvio M, Bruner DW, Scarantino C, Ivker R, Roach M 3rd, Suh J, Demas WF, Movsas B, Petersen IA, Konski AA (2008) Can physicians accurately predict survival time in patients with metastatic cancer? Analysis of RTOG 97-14. J Palliat Med 11(5):723–728

    PubMed  Google Scholar 

  27. Holmebakk T, Solbakken A, Mala T, Nesbakken A (2011) Clinical prediction of survival by surgeons for patients with incurable abdominal malignancy. Eur J Surg Oncol 37(7):571–575

    CAS  PubMed  Google Scholar 

  28. Kondziolka D, Parry PV, Lunsford D, Kano H, Flickinger JC, Rakfal S, Arai Y, Loeffler JS, Rush S, Knisely PS, Sheehan J, Friedman W, Tarhini A, Francis L, Lieberman F, Ahluwalia MS, Linskey ME, McDermott M, Sperduto P, Stupp R (2014) The accuracy of predicting survival in individual patients with cancer. J Neurosurg 120:24–30

    PubMed  Google Scholar 

  29. Lam PT (2008) Accuracy of clinical prediction of survival in a palliative care unit. Prog Palliat Care 16(3):113–117

    Google Scholar 

  30. Lambden J, Zhang B, Friedlander R, Prigerson HG (2016) Accuracy of oncologists’ life-expectancy estimates recalled by their advanced cancer patients: correlates and outcomes. J Palliat Med 19(12):1296–1303

    PubMed  PubMed Central  Google Scholar 

  31. Llobera J, Esteva M, Rifà J, Benito E, Terrasa J, Rojas C, Pons O, Catalàn G, Avellà A (2000) Terminal cancer: duration and prediction of survival time. Eur J Cancer 36(16):2036–2043

    CAS  PubMed  Google Scholar 

  32. Muers MF, Shevlin P, Brown J, on behalf of the participating members of the Thoracic Group of the Yorkshire Cancer organization (1996) Prognosis in lung cancer: physicians’ opinions compared with outcome and a predictive model. Thorax 51:894–902

    CAS  PubMed  PubMed Central  Google Scholar 

  33. Amano K, Maeda I, Shimoyama S, Shinjo T, Shirayama H, Yamada T, Ono S, Yamamoto R, Yamamoto N, Shishido H, Shimizu M, Kawahara M, Aoki S, Demizu A, Goshima M, Goto K, Gyoda Y, Hashimoto K, Otomo S, Sekimoto M, Shibata T, Sugimoto Y, Morita T (2015) The accuracy of physicians’ clinical predictions of survival in patients with advanced cancer. J Pain Symptom Manag 50(2):139–146

    Google Scholar 

  34. Bruera E, Miller MJ, Kuehn N, MacEachern T, Hanson J (1992) Estimate of survival of patients admitted to a palliative care unit: a prospective study. J Pain Symptom Manag 7(2):82–86

    CAS  Google Scholar 

  35. Faris M (2003) Clinical estimation of survival and impact of other prognostic factors on terminally ill cancer patients in Oman. Support Care Cancer 11(1):30–34

    PubMed  Google Scholar 

  36. Le F, Lynn J (1988) Predicting life span for applicants to inpatient hospice. Arch Intern Med 148(12):2540–2543

    Google Scholar 

  37. Fromme EK, Smith DM, Bascom PB, Kenworthy-Heinige T, Lyons KS, Tolle SW (2010) Incorporating routine survival prediction in a U.S. hospital-based palliative care service. J Palliat Med 13(12):1439–1444

    PubMed  PubMed Central  Google Scholar 

  38. Heyse-Moore LH, Johnson-Bell VE (1987) Can doctors accurately predict the life expectancy of patients with terminal cancer? Palliat Med 1:165–166

    Google Scholar 

  39. Morita T, Tsunoda J, Inoue S, Chihara S (2001) Improved accuracy of physicians’ survival prediction for terminally ill cancer patients using the Palliative Prognostic Index. Palliat Med 15:419–424

    CAS  PubMed  Google Scholar 

  40. Oxenham D, Cornbleet MA (1998) Accuracy of prediction of survival by different professional groups in a hospice. Palliat Med 12(2):117–118

    CAS  PubMed  Google Scholar 

  41. Parkes CM (1972) Accuracy of predictions of survival in later stages of cancer. Br Med J 2(5804):29–31

    CAS  PubMed  PubMed Central  Google Scholar 

  42. Perez-Cruz PE, Dos Santos R, Buosi Silva T, Crovador CS, De Angelis Nascimento MS, Hall S, Fajardo J, Bruera E, Hui D (2014) Longitudinal temporal and probabilistic prediction of survival in a cohort of patients with advanced cancer. J Pain Symptom Manag 48(5):875–882

    Google Scholar 

  43. Stiel S, Bertram L, Neuhaus S, Nauck F, Ostgathe C, Elsner F, Radbruch L (2010) Evaluation and comparison of two prognostic scores and the physicians’ estimate of survival in terminally ill patients. Support Care Cancer 18(1):43–49

    CAS  PubMed  Google Scholar 

  44. Tavares T, Oliveira M, Goncalves J, Trocado V, Perpetuo J, Azevedo A, Machado F, Barreto V, Rocha C (2017) Predicting prognosis in patients with advanced cancer: a prospective study. Palliat Med 32(2):413–416

    PubMed  Google Scholar 

  45. Urahama N, Sono J, Yoshinaga K (2018) Comparison of the accuracy and characteristics of the prognostic prediction of survival of identical terminally ill cancer patients by oncologists and palliative care physicians. Jpn J Clin Oncol 48(7):695–698

    PubMed  Google Scholar 

  46. Zibelman M, Xiang Q, Muchka S, Nickoloff S, Marks S (2014) Assessing prognostic documentation and accuracy among palliative care clinicians. J Palliat Med 17(5):521–526

    PubMed  Google Scholar 

Download references

Acknowledgments

We are grateful to Prof Silvio Garattini for his useful comments. We thank J. D. Baggott for kindly editing the paper. The investigators of Via di Natale hospice are as follows: Lamia Channoufi, Patrizia Garlatti, Adrian Fusco, Fabiola Breda, Lorena Doimo, Chiara Mazzariol, Anna Piccoli, Roberto Mancin, Stefan Sandru, Simone Bagnariol, Sebastiana Porceddu, Vara Tshimbalanga, Karolina Wasilewska, and Carmen Gallini.

Funding

Sara Mandelli is the recipient of a grant from the Via di Natale association, Aviano, Pordenone, Italy.

Author information

Authors and Affiliations

  1. Laboratory of Geriatric Neuropsychiatry, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156, Milan, Italy

    Sara Mandelli, Emma Riva, Mauro Tettamanti & Ugo Lucca

  2. Via di Natale Hospice, Aviano, Pordenone, Italy

    Davide Lombardi, Gianmaria Miolo, Simon Spazzapan & Rita Marson

Authors
  1. Sara Mandelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Emma Riva
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mauro Tettamanti
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ugo Lucca
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Davide Lombardi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Gianmaria Miolo
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Simon Spazzapan
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Rita Marson
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

on behalf of the Via di Natale Hospice investigators

Corresponding author

Correspondence to Sara Mandelli.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Study procedures were conducted in accordance with the principles outlined in the Declaration of Helsinki of 1964 and its subsequent amendments. Since clinical data were retrieved from medical records and hospice staff made survival predictions without involving the patients, informed consent was not required.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

ESM 1

(DOCX 67 kb)

ESM 2

(DOCX 19 kb)

ESM 3

(DOCX 22 kb)

ESM 4

(DOCX 24 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mandelli, S., Riva, E., Tettamanti, M. et al. How palliative care professionals deal with predicting life expectancy at the end of life: predictors and accuracy. Support Care Cancer 29, 2093–2103 (2021). https://doi.org/10.1007/s00520-020-05720-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-020-05720-6

Keywords

Search

Navigation