TY - JOUR
T1 - The impact of a web-based prognostic calculator on prognostic confidence in outpatient palliative care
AU - Hui, David
AU - Maxwell, John P.
AU - de la Rosa, Allison
AU - Jennings, Kristofer
AU - Vidal, Marieberta
AU - Reddy, Akhila
AU - Azhar, Ahsan
AU - Dev, Rony
AU - Tanco, Kimberson
AU - Heung, Yvonne
AU - Delgado-Guay, Marvin
AU - Zhukovsky, Donna
AU - Arthur, Joseph
AU - Reddy, Suresh
AU - Yennu, Sriram
AU - Ontai, Amy
AU - Bruera, Eduardo
N1 - Publisher Copyright:
© The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2024.
PY - 2024/11
Y1 - 2024/11
N2 - Purpose: Clinicians are often uncertain about their prognostic estimates, which may impede prognostic communication and clinical decision-making. We assessed the impact of a web-based prognostic calculator on physicians’ prognostic confidence. Methods: In this prospective study, palliative care physicians estimated the prognosis of patients with advanced cancer in an outpatient clinic using the temporal, surprise, and probabilistic approaches for 6 m, 3 m, 2 m, 1 m, 2 w, 1 w, and 3 d. They then reviewed information from www.predictsurvival.com, which calculated survival estimates from seven validated prognostic scores, including the Palliative Prognostic Score, Palliative Prognostic Index, and Palliative Performance Status, and again provided their prognostic estimates after calculator use. The primary outcome was prognostic confidence in temporal CPS (0–10 numeric rating scale, 0 = not confident, 10 = most confident). Results: Twenty palliative care physicians estimated prognoses for 217 patients. The mean (standard deviation) prognostic confidence significantly increased from 5.59 (1.68) before to 6.94 (1.39) after calculator use (p < 0.001). A significantly greater proportion of physicians reported feeling confident enough in their prognosis to share it with patients (44% vs. 74%, p < 0.001) and formulate care recommendations (80% vs. 94%, p < 0.001) after calculator use. Prognostic accuracy did not differ significantly before or after calculator use, ranging from 55–100%, 29–98%, and 48–100% for the temporal, surprise, and probabilistic approaches, respectively. Conclusion: This web-based prognostic calculator was associated with increased prognostic confidence and willingness to discuss prognosis. Further research is needed to examine how prognostic tools may augment prognostic discussions and clinical decision-making.
AB - Purpose: Clinicians are often uncertain about their prognostic estimates, which may impede prognostic communication and clinical decision-making. We assessed the impact of a web-based prognostic calculator on physicians’ prognostic confidence. Methods: In this prospective study, palliative care physicians estimated the prognosis of patients with advanced cancer in an outpatient clinic using the temporal, surprise, and probabilistic approaches for 6 m, 3 m, 2 m, 1 m, 2 w, 1 w, and 3 d. They then reviewed information from www.predictsurvival.com, which calculated survival estimates from seven validated prognostic scores, including the Palliative Prognostic Score, Palliative Prognostic Index, and Palliative Performance Status, and again provided their prognostic estimates after calculator use. The primary outcome was prognostic confidence in temporal CPS (0–10 numeric rating scale, 0 = not confident, 10 = most confident). Results: Twenty palliative care physicians estimated prognoses for 217 patients. The mean (standard deviation) prognostic confidence significantly increased from 5.59 (1.68) before to 6.94 (1.39) after calculator use (p < 0.001). A significantly greater proportion of physicians reported feeling confident enough in their prognosis to share it with patients (44% vs. 74%, p < 0.001) and formulate care recommendations (80% vs. 94%, p < 0.001) after calculator use. Prognostic accuracy did not differ significantly before or after calculator use, ranging from 55–100%, 29–98%, and 48–100% for the temporal, surprise, and probabilistic approaches, respectively. Conclusion: This web-based prognostic calculator was associated with increased prognostic confidence and willingness to discuss prognosis. Further research is needed to examine how prognostic tools may augment prognostic discussions and clinical decision-making.
KW - Clinical decision-making
KW - Forecasting
KW - Neoplasms
KW - Palliative care
KW - Prognosis
KW - Self-confidence
UR - http://www.scopus.com/inward/record.url?scp=85205760205&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85205760205&partnerID=8YFLogxK
U2 - 10.1007/s00520-024-08911-7
DO - 10.1007/s00520-024-08911-7
M3 - Article
C2 - 39377783
AN - SCOPUS:85205760205
SN - 0941-4355
VL - 32
JO - Supportive Care in Cancer
JF - Supportive Care in Cancer
IS - 11
M1 - 714
ER -