A Comparison of the Accuracy of Clinician Prediction of Survival Versus the Palliative Prognostic Index
A Comparison of the Accuracy of Clinician Prediction of Survival Versus the Palliative Prognostic Index
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DOI：
10.1016/j.jpainsymman.2017.11.028
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发表时间：
2018-03-01
影响因子：
4.7
通讯作者：
Hui, David
中科院分区：
文献类型：
--
作者：
Farinholt, Paige;Park, Minjeong;Hui, David
上下文晚期癌症患者的生存预测影响护理的许多方面，但临床医生生存预测（CPS）的准确性较低。已经提出了诸如姑息性预后指数（PPI）的预后工具来提高预测的准确性。然而，目前尚不清楚PPI在区分生存率方面是否比CPS更好。Objective。我们比较了CPS与PPI在晚期癌症患者中的预后准确性。这是一项前瞻性研究，我们三级癌症中心的姑息治疗医生记录了晚期癌症住院患者的PPI和CPS。我们使用一致性统计、受试者工作特征曲线下面积（AUC）、净重新分类指数以及30天生存率和100天生存率的综合区分改善来比较CPS和PPI的区分。215例患者入组，中位生存期为109天，中位随访期为239天。PPI和CPS的30天生存期AUC分别为0.76（95% CI 0.66-0.85）和0.58（95% CI 0.47-0.68）（P < 0.0001）。使用净重新分类指数，67%的患者使用PPI而不是CPS正确重新分类30天生存率（P = 0.0005）。CPS和PPI对100天生存率的准确性相似（AUC 0.62 vs. 0.64; P = 0.58）。我们发现，PPI比CPS更准确，当用于区分生存在30天，但不是在100天。这项研究强调了使用PPI促进生存预测的原因和时机。(C)2017年美国临终关怀和姑息医学学会。爱思唯尔公司出版All rights reserved.
Context. Survival predictions for advanced cancer patients impact many aspects of care, but the accuracy of clinician prediction of survival (CPS) is low. Prognostic tools such as the Palliative Prognostic Index (PPI) have been proposed to improve accuracy of predictions. However, it is not known if PPI is better than CPS at discriminating survival.Objective. We compared the prognostic accuracy of CPS to PPI in patients with advanced cancer.Methods. This was a prospective study in which palliative care physicians at our tertiary care cancer center documented both the PPI and CPS in hospitalized patients with advanced cancer. We compared the discrimination of CPS and PPI using concordance statistics, area under the receiver-operating characteristics curve (AUC), net reclassification index, and integrated discrimination improvement for 30-day survival and 100-day survival.Results. Two hundred fifteen patients were enrolled with a median survival of 109 days and a median follow-up of 239 days. The AUC for 30-day survival was 0.76 (95% CI 0.66-0.85) for PPI and 0.58 (95% CI 0.47-0.68) for CPS (P < 0.0001). Using the net reclassification index, 67% of patients were correctly reclassified using PPI instead of CPS for 30-day survival (P = 0.0005). CPS and PPI had similar accuracy for 100-day survival (AUC 0.62 vs. 0.64; P = 0.58).Conclusion. We found that PPI was more accurate than CPS when used to discriminate survival at 30 days, but not at 100 days. This study highlights the reason and timing for using PPI to facilitate survival predictions. (C) 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.