Please use this identifier to cite or link to this item:
http://bura.brunel.ac.uk/handle/2438/24337
Title: | Imminent death: Clinician certainty and accuracy of prognostic predictions |
Authors: | White, N Reid, F Vickerstaff, V Harries, P Tomlinson, C Stone, P |
Issue Date: | 10-May-2019 |
Publisher: | BMJ |
Citation: | White, N., Reid F., Vickerstaff V., Harries, P., Tomlinson, C. and Stone, P. (2019) 'Imminent death: clinician certainty and accuracy of prognostic predictions', BMJ Supportive & Palliative Care, 12 (e6), pp. e785 - e791 (7). doi: 10.1136/bmjspcare-2018-001761. |
Abstract: | Copyright © Author(s) (or their employer(s)) 2022. Objectives: To determine the accuracy of predictions of dying at different cut-off thresholds and to acknowledge the extent of clinical uncertainty. Design: Secondary analysis of data from a prospective cohort study. Setting: An online prognostic test, accessible by eligible participants across the UK. Participants: Eligible participants were members of the Association of Palliative Medicine. 99/166 completed the test (60%), resulting in 1980 estimates (99 participants × 20 summaries). Main outcome measures: The probability of death occurring within 72 hours (0% certain survival-100% certain death) for 20 patient summaries. The estimates were analysed using five different thresholds: 50/50%, 40/60%, 30/70%, 20/80% and 10/90%, with percentage values between these extremes being regarded as ? €? indeterminate'. The positive predictive value (PPV), negative predictive value (NPV) and the number of indeterminate cases were calculated for each cut-off. Results: Using a <50% versus >50% threshold produced a PPV of 62%, an NPV of 74% and 5% indeterminate cases. When the threshold was changed to ≤10% vs ≥90%, the PPV and NPV increased to 75% and 88%, respectively, at the expense of an increase of indeterminate cases up to 62%. Conclusion: When doctors assign a very high (≥90%) or very low (≤10%) probability of imminent death, their prognostic accuracy is improved; however, this increases the number of ? €? indeterminate' cases. This suggests that clinical predictions may continue to have a role for routine prognostication but that other approaches (such as the use of prognostic scores) may be required for those cases where doctors' estimates are indeterminate. |
Description: | Data sharing statement All data relevant to the study are included in the article or uploaded as supplementary information. |
URI: | https://bura.brunel.ac.uk/handle/2438/24337 |
DOI: | https://doi.org/10.1136/bmjspcare-2018-001761 |
ISSN: | 2045-435X |
Other Identifiers: | ORCID iDs: Nicola White https://orcid.org/0000-0002-7438-0072; Priscilla Harries https://orcid.org/0000-0003-3123-6799; Patrick Stone https://orcid.org/0000-0002-5765-9047. |
Appears in Collections: | Dept of Health Sciences Research Papers |
Files in This Item:
File | Description | Size | Format | |
---|---|---|---|---|
FullText.pdf | Copyright © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: https://creativecommons.org/licenses/by-nc/4.0/. | 565.12 kB | Adobe PDF | View/Open |
This item is licensed under a Creative Commons License