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Short report
Specialist palliative medicine physicians and nurses accuracy at predicting imminent death (within 72 hours): a short report
  1. Nicola White1,
  2. Fiona Reid2,
  3. Victoria Vickerstaff1,3,
  4. Priscilla Harries4,5 and
  5. Patrick Stone1
  1. 1 Marie Curie Palliative Care Research Department, University College London, London, UK
  2. 2 School of Population Health & Environmental Sciences, King's College London, London, UK
  3. 3 The Research Department of Primary Care and Population Health, University College London, London, UK
  4. 4 Faculty of Health, Social Care and Education, Kingston University & St Georges, University of London, London, UK
  5. 5 Department of Clinical Sciences, Brunel University, Uxbridge, UK
  1. Correspondence to Dr Nicola White, Marie Curie Palliative Care Research Department, University College London, London W1T7NF, UK; n.g.white{at}ucl.ac.uk

Abstract

Objectives Research suggests that clinicians are not very accurate at prognosticating in palliative care. The ‘horizon effect’ suggests that accuracy ought to be better when the survival of patients is shorter. The aim of this study was to determine the accuracy of specialist palliative care clinicians at identifying which patients are likely to die within 72 hours.

Design In a secondary data analysis of a prospective observational study, specialist palliative care doctors and nurses (in a hospice and a hospital palliative care team) provided survival predictions (yes/no/uncertain) about which patients would die within 72 hours.

Results Survival predictions were obtained for 49 patients. A prediction from a nurse was obtained for 37/49 patients. A prediction from a doctor was obtained for 46/49 patients. In total, 23 (47%)/49 patients actually died within 72 hours of assessment. Nurses accurately predicted the outcome in 27 (73%)/37 cases. Doctors accurately predicted the outcome in 30 (65%)/46 cases. When comparing predictions given on the same patients (27 [55%]/49), nurses were slightly better at recognising imminent death than doctors (positive predictive value (the proportion of patients who died when the clinician predicted death)=79% vs 60%, respectively). The difference in c-statistics (nurses 0.82 vs doctors 0.63) was not significant (p=0.13).

Conclusion Even when patients are in the terminal phase and close to death, clinicians are not very good at predicting how much longer they will survive. Further research is warranted to improve prognostication in this population.

  • prognosis
  • terminal care
https://creativecommons.org/licenses/by/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/bmjspcare-2020-002224

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    Footnotes

    • Twitter @Cilla_Harries

    • Contributors PS and PH initiated the PhD study idea, developed the design and aims of the study, monitored the data collection tools for the entire study and data collection, monitored the analysis of the results and revised the paper. NW developed the study concept, design and aims, designed data collection tools, completed the data collection for the whole study, cleaned and analysed the data and drafted and revised the paper. VV aided in the research aims, analysis and interpretation of the results. FR developed the design and aims of the study, monitored the data collection tools for the observational study and data collection, aided in the analysis of the results and revised the paper. All authors edited and approved the final version of the paper.

    • Funding Marie Curie I-CAN-CARE Program grant (MCCC-FPO-18-U). Professor Stone is supported by the Marie Curie Chair’s grant (MCCC-FCH-18-U). Nicola White, Victoria Vickerstaff and Patrick Stone are partly supported by the UCLH NIHR Biomedical Research Centre.

    • Disclaimer The funders had no role in trial design, data collection and analysis, decision to publish or preparation of the manuscript.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval The larger observational study received approval from West Midlands – Coventry and Warwickshire Research Ethics Committee (May 2014 (14/WM/0121).

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

    • Data availability statement All data relevant to the study are included in the article.