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Survival rates for terminally ill, often inaccurate

Study shows wide variation in errors

Jo Carlowe

Thursday, 15 September 2016

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. 

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.” 

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. 

Commenting on the findings, Stephanie Aiken, Deputy Director of Nursing for the Royal College of Nursing, said: “For a dying person and their loved ones, uncertainty can make a very distressing time much harder to deal with. Just as when we are born, the precise timing of death can be an inexact science – but nurses looking after people at the end of their lives recognise the positive impact of being as open as possible about what is observed, even if definitive answers can’t be given.

“As a society we have become much better at speaking about death and dying, and respecting and understanding people’s wishes at the end of their lives. But there is clearly more to do to improve recognition of the signs that someone is dying, and supporting families with information. This is a timely reminder from Marie Curie of the great skill, empathy and responsibility involved in caring for dying people.”

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.” 

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