Prognostic tools or clinical predictions: Which are better in palliative care?
Prognostic tools or clinical predictions: Which are better in palliative care?
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DOI：
10.1371/journal.pone.0249763
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发表时间：
2021
期刊：
影响因子：
3.7
通讯作者：
Omar RZ
中科院分区：
文献类型：
--
作者：
Stone P;Vickerstaff V;Kalpakidou A;Todd C;Griffiths J;Keeley V;Spencer K;Buckle P;Finlay D;Omar RZ
姑息预后（PaP）评分；姑息预后指数；Feliu预后Nomogram （FPN）和Palliative Performance Scale （PPS）都被认为是姑息性癌症治疗的预后工具。然而，临床判断仍然是姑息治疗专业人员确定预后的主要方式，将预后工具的性能与临床生存预测（CPS）进行比较是很重要的。这是一项预后工具的多中心队列验证研究。研究参与者是接受姑息治疗的成年晚期癌症患者，无论是否有同意的能力。在转诊到姑息治疗服务后不久，在基线收集关键预后数据。CPS分别由一名医生和一名护士独立获取。收集了1833名参与者的预后数据。所有的预后工具都显示出可接受的辨别和校准，但没有一个显示出CPS的优势。PaP和CPS同样能够根据患者在30天内死亡的风险准确地对患者进行分类。在根据患者在15、30或60天死亡的风险对患者进行分层时，CPS和FPN的表现没有差异。PPI在预测患者存活3周或6周方面明显（p<0.001）差于CPS。PPS和CPS都能够将姑息治疗患者区分为多个等预后组。虽然四种常用的姑息治疗预后算法普遍表现出良好的判别和校准，但没有一种算法表现出优于CPS的优势。准确性低于CPS的预后工具没有临床应用。然而，与CPS类似的预后工具可能有其他优点，可以推荐它们在临床实践中使用（例如，更客观，更可重复性，作为第二意见或作为教育工具）。因此，未来的研究应评估预后工具对临床实践和决策的影响。
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). 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. 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<0.001) worse than CPS at predicting which patients would survive for 3 or 6 weeks. PPS and CPS were both able to discriminate palliative care patients into multiple iso-prognostic groups. Although four commonly used prognostic algorithms for palliative care generally showed good discrimination and calibration, none of them demonstrated superiority to CPS. Prognostic tools which are less accurate than CPS are of no clinical use. However, prognostic tools which perform similarly to CPS may have other advantages to recommend them for use in clinical practice (e.g. being more objective, more reproducible, acting as a second opinion or as an educational tool). Future studies should therefore assess the impact of prognostic tools on clinical practice and decision-making.
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