Perez-Cruz Pedro E, Dos Santos Renata, Silva Thiago Buosi, Crovador Camila Souza, Nascimento Maria Salete de Angelis, Hall Stacy, Fajardo Julieta, Bruera Eduardo, Hui David
Programa Medicina Paliativa y Cuidados Continuos, Departamento Medicina Interna, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
Department of Palliative Care, Barretos Cancer Hospital, Barretos, Brazil.
J Pain Symptom Manage. 2014 Nov;48(5):875-82. doi: 10.1016/j.jpainsymman.2014.02.007. Epub 2014 Apr 16.
Survival prognostication is important during the end of life. The accuracy of clinician prediction of survival (CPS) over time has not been well characterized.
The aims of the study were to examine changes in prognostication accuracy during the last 14 days of life in a cohort of patients with advanced cancer admitted to two acute palliative care units and to compare the accuracy between the temporal and probabilistic approaches.
Physicians and nurses prognosticated survival daily for cancer patients in two hospitals until death/discharge using two prognostic approaches: temporal and probabilistic. We assessed accuracy for each method daily during the last 14 days of life comparing accuracy at Day -14 (baseline) with accuracy at each time point using a test of proportions.
A total of 6718 temporal and 6621 probabilistic estimations were provided by physicians and nurses for 311 patients, respectively. Median (interquartile range) survival was 8 days (4-20 days). Temporal CPS had low accuracy (10%-40%) and did not change over time. In contrast, probabilistic CPS was significantly more accurate (P < .05 at each time point) but decreased close to death.
Probabilistic CPS was consistently more accurate than temporal CPS over the last 14 days of life; however, its accuracy decreased as patients approached death. Our findings suggest that better tools to predict impending death are necessary.
生存预后评估在生命末期至关重要。临床医生对生存时间的预测准确性（CPS）随时间的变化情况尚未得到充分描述。
本研究旨在探讨入住两个急性姑息治疗病房的晚期癌症患者队列在生命最后14天内预后评估准确性的变化，并比较时间法和概率法之间的准确性。
医生和护士使用时间法和概率法这两种预后评估方法，每天对两家医院的癌症患者进行生存预后评估，直至患者死亡或出院。在生命的最后14天里，我们每天评估每种方法的准确性，使用比例检验将第-14天（基线）的准确性与每个时间点的准确性进行比较。
医生和护士分别为311例患者提供了6718次时间法和6621次概率法的评估。中位（四分位间距）生存时间为8天（4-20天）。时间法CPS的准确性较低（10%-40%），且不随时间变化。相比之下，概率法CPS显著更准确（每个时间点P < 0.05），但在接近死亡时准确性下降。
在生命的最后14天里，概率法CPS始终比时间法CPS更准确；然而，随着患者接近死亡，其准确性会下降。我们的研究结果表明，需要更好的工具来预测即将到来的死亡。
