Palliative Care Clinician Overestimation of Survival in Advanced Cancer: Disparities and Association With End-of-Life Care.
Maine Medical Center Research Institute
Journal of pain and symptom management
Adult, Aged, Aged, 80 and over, Cohort Studies, Ethnic Groups, Female, Humans, Inpatients, Male, Middle Aged, Neoplasms, Palliative Care, Prognosis, Socioeconomic Factors, Surveys and Questionnaires, Survival Analysis, Terminal Care
CONTEXT: Clinicians frequently overestimate survival time in serious illness.
OBJECTIVE: The objective of this study was to understand the frequency of overestimation in palliative care (PC) and the relation with end-of-life (EOL) treatment.
METHODS: This is a multisite cohort study of 230 hospitalized patients with advanced cancer who consulted with PC between 2013 and 2016. We asked the consulting PC clinician to make their "best guess" about the patients' "most likely survival time, assuming that their illnesses are allowed to take their natural course" (<24 >hours; 24 hours to less than two weeks; two weeks to less than three months; three months to less than six months; six months or longer). We followed patients for up to six month for mortality and EOL treatment utilization. Patients completed a brief interviewer-facilitated questionnaire at study enrollment.
RESULTS: Median survival was 37 days (interquartile range: 12 days, 97 days) and 186/230 (81%) died during the follow-up period. Forty-one percent of clinicians' predictions were accurate. Among inaccurate prognoses, 85% were overestimates. Among those who died, overestimates were substantially associated with less hospice use (OR
CONCLUSION: Overestimation is common in PC, associated with lower hospice use and a potentially mutable source of racial/ethnic disparity in EOL care.
Gramling, Robert; Gajary-Coots, Elizabeth; Cimino, Jenica; Fiscella, Kevin; Epstein, Ronald; Ladwig, Susan; Anderson, Wendy; Alexander, Stewart C; Han, Paul K; Gramling, David; and Norton, Sally A, "Palliative Care Clinician Overestimation of Survival in Advanced Cancer: Disparities and Association With End-of-Life Care." (2019). Maine Medical Center. 1495.