New research has shown that doctors are frequently inaccurate when predicting how long those living with terminal illnesses will survive.
Researchers at the Marie Curie Palliative Care Research Department at UCL combined the results of previous studies, reviewing 4,642 records of clinicians' predictions regarding survival of patients approaching the ends of their lives. The study revealed wide variation in errors, ranging from an underestimate of 86 days to an overestimate of 93 days.
The researchers had hoped to find that some doctors - for example, those who were more experienced or older - would be more accurate than others, but the review did not provide any clear evidence that this was the case.
The team at the Marie Curie Research Department at UCL are now conducting further work to identify whether it is possible to train doctors to make better predictions. To do this, they are studying what makes some doctors better at predicting survival than others - is it simply intuition, or is prognostic accuracy a skill that can be taught?
It is hoped that better identification of when patients are entering the last few days, weeks or months of life will in turn ensure that they receive appropriate palliative and end of life care.
Paddy Stone, Professor of Palliative and End of life care at the Marie Curie Research Department at UCL, said:
"Delivering the most appropriate care and treatments for those with terminal illnesses is often dependent on doctors making an accurate prognosis. Knowing how much time is left can also better equip patients and their carers to make more informed choices about their care. This research suggests that there is no simple way to identify which doctors are better at predicting survival. Being more senior or more experienced does not necessarily make one a better prognosticator but we now want to see if we can identify how and why some doctors are better at predicting survival than others and to determine if this is a skill that can be taught."
Janice Jones, whose father Stephen Flint, died in 2011 from bile duct cancer, explains the impact of uncertainty over how long her father would survive from his condition. She says:
"We weren't given an accurate timescale, the doctor was very non-committal. While some people would prefer not to know, having an idea of how much time dad had left would have made us feel more in control of the situation. What hurt the most was that the doctor had seen dad just before the evening that he died and hadn't given us any indication that it would be so soon. Knowing would have allowed us to fill our last days with memories rather than get so bogged down in the routine responsibilities of caring for someone who is dying."
Professor Bill Noble, Medical Director at Marie Curie, said:
"Making an accurate prediction about length of survival is very difficult, even at the very end. While we may be able to improve the accuracy of predictions, these will ultimately always be expressed in terms of risk of death within a particular time frame. No two people are the same - every illness carries a variety of different possible outcomes depending on the individual and the treatment they are receiving.
"Recognising that someone is likely to die from their illness means that we can provide the most appropriate care and have the opportunity for open and ongoing conversations with the patient and their family about what to expect. However, pain and other symptoms associated with terminal illnesses require treatment regardless of whether someone lives days, weeks or months. What is important is that clinicians provide the best possible palliative care based on the individual's need, regardless of how long they expect them to survive."
Article: A Systematic Review of Predictions of Survival in Palliative Care: How Accurate Are Clinicians and Who Are the Experts? Nicola White , Fiona Reid, Adam Harris, Priscilla Harries, Patrick Stone, PLOS ONE, doi: 10.1371/journal.pone.0161407, published 25 August 2016.