WP2.1 Training in prognostication

WP2.1 consists of:

  1. A systematic review reporting the accuracy of clinical predictions of survival in a palliative care setting. The results highlighted three things: 1) there was vast variability within clinical predictions of survival 2) there was a high degree of heterogeneity across the studies included in the review 3) there were no "expert" prognosticators (i.e. one profession was not consistently better than another).
  2. A systematic review looking at the accuracy of using the "Surprise Question" (e.g. would you be surprised if this person died within 12 months?) as a prognostic tool.
  3. The development of an online educational training package to improve the ability of novice healthcare professionals at recognising a dying patient. The training package will be developed using input from our P:CES study, where we identified key pieces of prognostic information used by palliative care doctors to identify patients who are dying.
  4. The educational training package will be evaluated in a randomised controlled trial to assess effectiveness. The primary outcome will be the correlation between the novices' and experts' estimates of the probability of patients dying within the next 72 hours.

Research background

Clinicians are routinely asked to predict death, or to provide a prognostic estimate of survival, in order to decide future treatment plans. "How long have I got left" is a question commonly asked. The accuracy of these predictions are valued by patients, their family members, and by clinicians (Adams, Boulton, & Watson, 2009; Degner et al., 1997; Kirk, Kirk, & Kristjanson, 2004; Kutner, Steiner, Corbett, Jahnigen, & Barton, 1999; Steinhauser et al., 2001; Steinhauser et al., 2000); they mean the difference between undergoing a lifesaving operation and opting for conservative management.

Several reports have highlighted that the recognition of the dying phase (last 72 hours of life) was inaccurate (Neuberger et al., 2013; Parry, Seymour, Whittaker, Bird, & Cox, 2013; Leadership Alliance for the Care of Dying People, 2014; Parliamentary and Health Service Ombudsman, 2015). In addition to this, virtually no education or training resources have been developed or evaluated to specifically nurture this skill or to help inexperienced clinical staff to improve their performance.

For more information please contact: Linda Oostendorp.