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Prognostic tools or clinical predictions: Which are better in palliative care?

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Listed:
  • P Stone
  • V Vickerstaff
  • A Kalpakidou
  • C Todd
  • J Griffiths
  • V Keeley
  • K Spencer
  • P Buckle
  • D Finlay
  • R Z Omar

Abstract

Purpose: The Palliative Prognostic (PaP) score; Palliative Prognostic Index (PPI); Feliu Prognostic Nomogram (FPN) and Palliative Performance Scale (PPS) have all been proposed as prognostic tools for palliative cancer care. However, clinical judgement remains the principal way by which palliative care professionals determine prognoses and it is important that the performance of prognostic tools is compared against clinical predictions of survival (CPS). Methods: This was a multi-centre, cohort validation study of prognostic tools. Study participants were adults with advanced cancer receiving palliative care, with or without capacity to consent. Key prognostic data were collected at baseline, shortly after referral to palliative care services. CPS were obtained independently from a doctor and a nurse. Results: Prognostic data were collected on 1833 participants. All prognostic tools showed acceptable discrimination and calibration, but none showed superiority to CPS. Both PaP and CPS were equally able to accurately categorise patients according to their risk of dying within 30 days. There was no difference in performance between CPS and FPN at stratifying patients according to their risk of dying at 15, 30 or 60 days. PPI was significantly (p

Suggested Citation

  • P Stone & V Vickerstaff & A Kalpakidou & C Todd & J Griffiths & V Keeley & K Spencer & P Buckle & D Finlay & R Z Omar, 2021. "Prognostic tools or clinical predictions: Which are better in palliative care?," PLOS ONE, Public Library of Science, vol. 16(4), pages 1-18, April.
    • Handle: RePEc:plo:pone00:0249763
    DOI: 10.1371/journal.pone.0249763
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