Montreal Institute for Palliative Care, Montreal, Quebec, Canada.
Teresa Dellar Palliative Care Residence, Kirkland, Quebec, Canada.
J Palliat Med. 2024 Jul;27(7):895-904. doi: 10.1089/jpm.2023.0675. Epub 2024 Mar 8.
Life expectancy prediction is important for end-of-life planning. Established methods (Palliative Performance Scale [PPS], Palliative Prognostic Index [PPI]) have been validated for intermediate- to long-term prognoses, but last-weeks-of-life prognosis has not been well studied. Patients admitted to a palliative care facility often have a life expectancy of less than three weeks. Reliable last-weeks-of-life prognostic tools are needed. To improve short-term survival prediction in terminally ill patients. This prospective study included all patients admitted to a palliative care facility in Montreal, Canada, over one year. PPS and PPI were assessed until patients' death. Seven prognostic clinical signs of impending death (Short-Term Prognosis Signs [SPS]) were documented daily. The analyses included 273 patients (76% cancer). The median survival time for a PPS ≤20% was 2.5 days, while for a PPS ≥50% it was 44.5 days, for a PPI >8 the median survival was 3.5 days and for a PPI ≤4 it was 38.5 days. Receiver operating characteristic curves showed a high accuracy in predicting survival. Median survival after the first occurrence of any SPS was below one week. This study demonstrated that the PPS and PPI perform well between one week and three months extending their usefulness to shorter term survival prediction. SPS items provided survival information during the last week of life. Using SPS along with PPS and PPI during the last weeks of life could enable a more precise short-term survival prediction across various end-of-life diagnoses. The translation of this research into clinical practice could lead to a better adapted treatment, the identification of a most appropriate care setting for patients, and improved communication of prognosis with patients and families.
预期寿命预测对于临终规划很重要。已建立的方法（姑息治疗表现量表[PPS]、姑息预后指数[PPI]）已被验证可用于中至长期预后，但对生命最后几周的预后研究不足。入住姑息治疗机构的患者的预期寿命通常不到三周。需要可靠的生命最后几周的预后工具。 为了提高终末期患者的短期生存率。 这项前瞻性研究包括在加拿大蒙特利尔的一家姑息治疗机构住院的所有患者，为期一年。在患者死亡之前评估 PPS 和 PPI。每天记录七个预示死亡的临床预后体征（短期预后体征[SPS]）。 分析包括 273 名患者（76%为癌症）。PPS≤20%的中位生存时间为 2.5 天，而 PPS≥50%的中位生存时间为 44.5 天，PPI>8 的中位生存时间为 3.5 天，PPI≤4 的中位生存时间为 38.5 天。接受者操作特征曲线显示出预测生存率的高度准确性。任何 SPS 首次出现后的中位生存时间均低于一周。 这项研究表明，PPS 和 PPI 在一周至三个月之间表现良好，将其用途扩展到更短期的生存率预测。SPS 项目在生命的最后一周提供了生存信息。在生命的最后几周使用 SPS 与 PPS 和 PPI 结合使用，可以更准确地预测各种临终诊断的短期生存率。将这项研究转化为临床实践，可以为患者提供更适应的治疗、确定最合适的护理环境，并改善与患者和家属的预后沟通。
