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Patients' reports or clinicians' assessments: which are better for prognosticating?
  1. Paddy Stone1,
  2. Bridget Gwilliam1,
  3. Vaughan Keeley2,
  4. Chris Todd3,
  5. Matthew Gittins4,
  6. Laura Kelly5,
  7. Stephen Barclay6 and
  8. Chris Roberts4
  1. 1Division of Population, Health Sciences and Education, St George's University of London, London, UK
  2. 2Department of Palliative Care, Royal Derby Hospital, Derby, UK
  3. 3School of Nursing, Midwifery & Social Work, Jean McFarlane Building, The University of Manchester, Manchester, UK
  4. 4Health Sciences, School of Community Based Medicine, Jean McFarlane Building, The University of Manchester, Manchester, UK
  5. 5Department of Palliative Medicine, Surrey and Sussex Healthcare NHS Trust, Surrey, UK
  6. 6General Practice and Primary Care Research Unit, University of Cambridge, Institute of Public Health, Cambridge, UK
  1. Correspondence to Paddy Stone, Division of Population, Health Sciences and Education, St George's University of London, London SW17 ORE, UK; pstone{at}


Background The Prognosis in Palliative care Scale (PiPS) predicts survival in advanced cancer patients more accurately than a doctor's or a nurse's estimate. PiPS scores are derived using observer ratings of symptom severity and performance status. The purpose of this study was to determine whether patient-rated data would provide better prognostic estimates than clinician observer ratings.

Patients and methods 1018 subjects with advanced cancer no longer undergoing tumour-directed therapy were recruited to a multi-centre study. Prognostic models were developed using observer ratings, patient ratings or a composite method that used patient ratings when available or else used observer ratings. The performance of the prognostic models was compared by determining the agreement between the models' predictions and the survival of study participants.

Results All three approaches to model development resulted in prognostic scores that were able to differentiate between patients with a survival of ‘days’, ‘weeks’ or ‘months+’. However, the observer-rated models were significantly (p<0.05) more accurate than the patient-rated models.

Conclusions A prognostic model derived using observer-rated data was more accurate at predicting survival than a similar model derived using patient self-report measures. This is clinically important because patient-rated data can be burdensome and difficult to obtain in patients with terminal illnesses.

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  • Funding CRUK grant number C11075/A6126.

  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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