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Clinician estimates of prognosis: accuracy and impact—a retrospective inpatient hospice study
  1. Simon Tavabie1,
  2. Anya Hargreaves2,
  3. Adrian Tookman3 and
  4. Patrick Stone4
  1. 1Palliative Medicine, Barts Health NHS Trust, London, UK
  2. 2General internal medicine, West Hertfordshire NHS Trust, London, UK
  3. 3Palliative Medicine, Marie Curie Hospice, London, UK
  4. 4Marie Curie Palliative Care Research Department, University College London, London, UK
  1. Correspondence to Dr Simon Tavabie, Palliative Medicine, Barts Health NHS Trust, London, London, UK; simon.tavabie{at}nhs.net

Abstract

Objective To evaluate the accuracy and impact of clinicians’ estimates of prognosis (CEP) in patients referred for hospice inpatient care.

Methods Retrospective review of 12 months’ referrals to a London hospice unit. Data extracted included date of referral, admission and death and CEP.

Results N=383. Mean age 72 years (range 24–101). CEP accuracy: Median survival where CEP was ‘days’ (n=141) was 7 days (0–164); CEP ‘weeks’ (n=167) was 14 days (1–538); CEP ‘months’ (n=75) was 32 days (2–507). Kaplan-Meier survival curves showed significant difference between CEP of ‘months’ and ‘weeks’ (p<0.0001); ‘months’ and ‘days’ (p<0.0001); but not ‘days’ and ‘weeks’ (p=0.1). CEP impact: admission waiting time increased with increasing CEP: CEP ‘days’ (n=105) median 1 day (0–14); CEP ‘weeks’ (n=154) median 2 days (0–46); CEP ‘months’ (n=69) median 3 days (0–46). No significant difference was demonstrated in the number of discharge planning conversations between groups (0.9/patient).

Conclusions CEP was accurate in over half of the cases but did not adequately discriminate between those with prognoses of days or weeks. CEP may affect the prioritisation given to patients by hospices. Inaccurate CEP on referral forms may influence other aspects of care; however, further research is needed.

  • prognosis
  • hospice care
  • service evaluation
  • survivorship
  • terminal care

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Footnotes

  • Twitter @simontavabie

  • Contributors PS and ST conceived the project. ST and AH collected the data. All authors oversaw the production and revisions to the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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