Prognostic tools or clinical predictions: Which are better in palliative care?

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Abstract

Purpose

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).

Methods

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.

Results

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.

Conclusions

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.

Related collections

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Author and article information

Contributors

P. Stone:

ORCID: https://orcid.org/0000-0002-5765-9047

Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: MethodologyRole: Project administrationRole: SupervisionRole: Writing – original draftRole: Writing – review & editing

V. Vickerstaff:

ORCID: https://orcid.org/0000-0002-3119-670X

Role: Formal analysisRole: Project administrationRole: Writing – original draftRole: Writing – review & editing

A. Kalpakidou: Role: Data curationRole: Project administrationRole: SupervisionRole: Writing – review & editing

C. Todd: Role: ConceptualizationRole: Formal analysisRole: Funding acquisitionRole: MethodologyRole: Project administrationRole: SupervisionRole: Writing – original draftRole: Writing – review & editing

J. Griffiths: Role: ConceptualizationRole: Formal analysisRole: Funding acquisitionRole: MethodologyRole: Project administrationRole: SupervisionRole: Writing – original draftRole: Writing – review & editing

V. Keeley: Role: ConceptualizationRole: MethodologyRole: Project administrationRole: SupervisionRole: Writing – review & editing

K. Spencer: Role: Data curationRole: Formal analysisRole: Writing – original draftRole: Writing – review & editing

P. Buckle: Role: Data curationRole: Formal analysisRole: InvestigationRole: Writing – review & editing

D. Finlay: Role: Data curationRole: Formal analysisRole: InvestigationRole: Writing – review & editing

R. Z. Omar: Role: ConceptualizationRole: Formal analysisRole: Funding acquisitionRole: MethodologyRole: SupervisionRole: Writing – original draftRole: Writing – review & editing

Tim Luckett: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS One

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 28 April 2021

Publication date Collection: 2021

Publication date (Corrected, electronic): 3 May 2021

Volume: 16

Issue: 4

Electronic Location Identifier: e0249763

Affiliations

[1 ] Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London (UCL), London, United Kingdom

[2 ] Faculty of Biology, Medicine and Health, School of Health Sciences, The University of Manchester, Manchester, United Kingdom

[3 ] Manchester Academic Health Science Centre, Manchester, United Kingdom

[4 ] Manchester University NHS Foundation Trust, Manchester, United Kingdom

[5 ] Palliative Medicine Department, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, United Kingdom

[6 ] Department of Statistical Science, University College London (UCL), London, United Kingdom

University of Technology Sydney, AUSTRALIA

Author notes

Competing Interests: Prof Stone, Prof Todd, Prof Omar, Prof Keeley and Dr Griffiths received grants from National Institute for Health Research, during the conduct of the study. No authors declare any financial relationships with any organisations that might have an interest in the submitted work in the previous three years, and no other relationships or activities that could appear to have influenced the submitted work.

* E-mail: p.stone@ 123456ucl.ac.uk

Author information

P. Stone https://orcid.org/0000-0002-5765-9047

V. Vickerstaff https://orcid.org/0000-0002-3119-670X

Article

Publisher ID: PONE-D-20-37715

DOI: 10.1371/journal.pone.0249763

PMC ID: 8081205

PubMed ID: 33909658

SO-VID: 9bdbb6b1-1a8d-4e6d-bd30-a612e86e75fe

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 1 December 2020

Date accepted : 25 March 2021