Background Prognostic estimates are used to support decision-making in advance care planning. NICE Quality Standards (2011) advocate that ‘people approaching the end of life are identified in a timely way’. Estimations are often inaccurate, with non-specialist medical professionals being accurate only 20% of the time.1 2 Prognostication scores exist to help inform estimations, but most medical professionals use a combination of personal experience, the patient's disease burden and momentum of functional decline.
Aim To determine prognostic accuracy of a specialist palliative care multi-disciplinary team (MDT).
Methods Prognostic estimates were recorded by a specialist palliative care MDT bi-weekly for hospice inpatients over a six month period. Patients were placed in to one of four prognostic categories: ‘last six months’, ‘last six weeks’, last two weeks', and ‘last 48 hours’. Data was collected retrospectively.
Results 182 prognostic estimates were recorded for 122 patients over six months. 96.8% of patients had a diagnosis of malignant disease. In the ‘last six months’ category, median survival was 42 days, with a prognostic accuracy of 48.6% (i.e. 48.6% of patients in this category died within six months and survived longer than six weeks). In the ‘last six weeks’ category, median survival was 21 days, with an accuracy of 43%. In the ‘last two weeks’ category, median survival was 8 days, with an accuracy of 50%. In the ‘last 48 hours’ category, median survival was 60 hours, with an accuracy of 52%.
Conclusions The specialist palliative care MDT is more accurate at estimating prognosis than non-specialist medical professionals, with an average accuracy over all prognostic categories of 48.4%. Accuracy improves the closer the patient is to death. Overestimation of prognosis is the more common error, contrary to media reports that suggest medical professionals can underestimate prognosis and deny patients treatment towards the end of life.
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