Current State of Prognosis
Why research prognosis?
There are many reasons to research how physicians prognosticate in palliative care.
- In some jurisdictions and institutions, palliative care or hospice care is provided only when a patient has a limited time to live; therefore, estimating survival helps to determine whether to admit a patient to the program. (16, 25 )
- Families often want and need to have some idea when their loved one might die - for instance, to arrange time off work or to travel to visit a sick relative.
- Patients often want to know how long they might have to live. When deciding how to spend the remainder of ones life, it may be helpful to know how much time may be left. (16)
How good are physicians at predicting survival?
In short: not very. Many studies have shown that physicians are inaccurate and tend to be overly optimistic when predicting survival for their patients. ( 2, 4, 6, 17, 20 ) Physician optimism is demonstrated below. Two studies showed that, when compared with actual survival, physician estimates were overly optimistic.
What tools are available for prognosis?
For more information on the models, click Prognostic Tools on the tool bar; for a detailed comparison between different models, click here.
There are a number of models and scales that physicians can use to predict survival. These are of varying quality and utility. In other areas of medicine there are predictive algorithms that are very useful, like the GCS, TNM staging and the Goldman criteria (12). In palliative care though, there are no formulas as good as these.
Why aren't these tools used more often?
There are several reasons why models that have been developed for Palliative Care are not used very often.
- Models don’t factor in treatments that may be offered to the patient
- There is often overfit (too many unique statistics applied to the testing population)
- There is little consensus on which clinical/laboratory variable should be included
- There are some clinical variables for which it is difficult to assign a number (23)
How will the research being done here help?
The impression is that palliative care physicians’ predictions are inaccurate and overly optimistic, but we’re not sure why. A survey conducted through the Palliative Care Medicine Program at Queen’s University was administered to all physicians who are members of the Canadian Society of Palliative Care Physicians. For more information about this research project view the publication link, survey used and supplemental tables and figures found on the main Prognostication webpage.