To supplement a clinician’s prediction of survival (CPS), several prognostic models, including the Palliative Performance Scale (PPS), Palliative Prognostic Index (PPI), and Palliative Prognostic Score (PaP), have been established. Few large-scale trials, however, have been done to demonstrate which prognostic tool performed better than CPS in patients with weeks of survival. Therefore, inpatients hospitalized in palliative care units (PCUs) were the population for which researchers compared the prognostic performance of the PPS, PPI, PaP, and CPS.
A multi-center prospective observational research involving patients hospitalized to PCUs in Japan included the study as one of its components. They calculated their prognostic accuracy using calibration plots for 7, 14, 30, and 60 days of survival and the area under the receiver operating characteristic curve (AUROC).
The median overall survival for the 1,896 patients we included was 19 days. The AUROC ranged from 73% to 84% for survival at 60 and 30 days, 75% to 84% for survival at 14 days, and 80% to 87% for survival at seven days. For the 4 indices in all periods, the calibration plot showed a reasonable level of agreement between the observational and prediction probabilities. As a result, all four prognostic indicators performed well. From one week to two months, CPS and PaP regularly outperformed PPS and PPI in a considerable way.
Patients hospitalized to PCUs with weeks of survival showed reasonably strong performance in the PPS, PPI, PaP, and CPS. In addition, the CPS and PaP performed noticeably better than the PPS and PPI. For doctors with expertise, CPS could be enough. However, PPS might boost their prognostic confidence if they are less skilled.