Baba Mika, Maeda Isseki, Morita Tatsuya, Hisanaga Takayuki, Ishihara Tatsuhiko, Iwashita Tomoyuki, Kaneishi Keisuke, Kawagoe Shohei, Kuriyama Toshiyuki, Maeda Takashi, Mori Ichiro, Nakajima Nobuhisa, Nishi Tomohiro, Sakurai Hiroki, Shimoyama Satofumi, Shinjo Takuya, Shirayama Hiroto, Yamada Takeshi, Ono Shigeki, Ozawa Taketoshi, Yamamoto Ryo, Tsuneto Satoru
Department of Palliative Care, Saito Yukoukai Hospital, Ibaragi, Osaka, Japan.
Department of Palliative Medicine, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan.
J Pain Symptom Manage. 2015 May;49(5):853-60. doi: 10.1016/j.jpainsymman.2014.10.010. Epub 2014 Dec 12.
Accurate prognostic information in palliative care settings is needed for patients to make decisions and set goals and priorities. The Prognosis Palliative Care Study (PiPS) predictor models were presented in 2011, but have not yet been fully validated by other research teams.
The primary aim of this study is to examine the accuracy and to validate the modified PiPS (using physician-proxy ratings of mental status instead of patient interviews) in three palliative care settings, namely palliative care units, hospital-based palliative care teams, and home-based palliative care services.
This multicenter prospective cohort study was conducted in 58 palliative care services including 16 palliative care units, 19 hospital-based palliative care teams, and 23 home-based palliative care services in Japan from September 2012 through April 2014.
A total of 2426 subjects were recruited. For reasons including lack of followup and missing variables (primarily blood examination data), we obtained analyzable data from 2212 and 1257 patients for the modified PiPS-A and PiPS-B, respectively. In all palliative care settings, both the modified PiPS-A and PiPS-B identified three risk groups with different survival rates (P<0.001). The absolute agreement ranged from 56% to 60% in the PiPS-A model and 60% to 62% in the PiPS-B model.
The modified PiPS was successfully validated and can be useful in palliative care units, hospital-based palliative care teams, and home-based palliative care services.
在姑息治疗环境中，需要准确的预后信息，以便患者做出决策并设定目标和优先级。预后姑息治疗研究（PiPS）预测模型于2011年提出，但尚未得到其他研究团队的充分验证。
本研究的主要目的是检验改良PiPS（使用医生对精神状态的代理评分而非患者访谈）在三种姑息治疗环境中的准确性并进行验证，这三种环境分别是姑息治疗病房、医院姑息治疗团队和居家姑息治疗服务。
这项多中心前瞻性队列研究于2012年9月至2014年4月在日本的58个姑息治疗服务机构中进行，包括16个姑息治疗病房、19个医院姑息治疗团队和23个居家姑息治疗服务机构。
共招募了2426名受试者。由于包括缺乏随访和变量缺失（主要是血液检查数据）等原因，我们分别从2212名和1257名患者中获得了改良PiPS-A和PiPS-B的可分析数据。在所有姑息治疗环境中，改良PiPS-A和PiPS-B均识别出三个生存率不同的风险组（P<0.001）。PiPS-A模型的绝对一致性范围为56%至60%，PiPS-B模型为60%至62%。
改良PiPS已成功验证，可用于姑息治疗病房、医院姑息治疗团队和居家姑息治疗服务。
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