Twomey Feargal, O'Leary Norma, O'Brien Tony
Marymount Hospice, St Patrick's Hospital, Wellington Road, Cork, Ireland.
Am J Hosp Palliat Care. 2008 Apr-May;25(2):139-45. doi: 10.1177/1049909107312594.
Accurate prognostication is an enormous challenge for professionals caring for patients with advanced disease. Few studies have compared the prognostic accuracy of different professional groups within a hospice setting. The aim of this study was to compare the ability of 5 professional groups to estimate the survival of patients admitted to a specialist palliative care unit. No group accurately predicted the length of patient survival more than 50% of the time. Nursing and junior medical staff were most accurate while care assistants were least accurate. When in error, senior clinical staff tended to under-estimate survival. Independent mobility on admission was the only variable predictive of length of survival. Thus, professional groups differ in their prognostic accuracy. An awareness of a group's propensity to over- or under-estimate prognosis should be incorporated into future work on prognostication models.
对于照料晚期疾病患者的专业人员而言,准确的预后判断是一项巨大的挑战。很少有研究比较临终关怀环境中不同专业群体的预后判断准确性。本研究的目的是比较5个专业群体评估入住专科姑息治疗病房患者生存情况的能力。没有一个群体能在超过50%的时间里准确预测患者的生存时长。护士和初级医务人员的判断最准确,而护理助理的判断最不准确。出现错误时,资深临床工作人员往往会低估生存时长。入院时的独立活动能力是唯一能预测生存时长的变量。因此,不同专业群体的预后判断准确性存在差异。在未来关于预后模型的工作中,应考虑到某个群体高估或低估预后的倾向。