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DC Field | Value | Language |
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dc.contributor.author | White, N | - |
dc.contributor.author | Reid, F | - |
dc.contributor.author | Vickerstaff, V | - |
dc.contributor.author | Harries, P | - |
dc.contributor.author | Tomlinson, C | - |
dc.contributor.author | Stone, P | - |
dc.date.accessioned | 2022-03-26T19:35:54Z | - |
dc.date.available | 2022-03-26T19:35:54Z | - |
dc.date.issued | 2019-05-10 | - |
dc.identifier | 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. | - |
dc.identifier.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. | en_US |
dc.identifier.issn | 2045-435X | - |
dc.identifier.uri | https://bura.brunel.ac.uk/handle/2438/24337 | - |
dc.description | Data sharing statement All data relevant to the study are included in the article or uploaded as supplementary information. | - |
dc.description.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. | en_US |
dc.description.sponsorship | UCL PhD Studentship; Marie Curie I-CAN-CARE Program grant (MCCC-FPO-16-U). Professor Stone is supported by the Marie Curie Chair’s grant (MCCC-509537). | en_US |
dc.format.extent | e785 - e791 | - |
dc.format.medium | Print-Electronic | - |
dc.language.iso | en | en_US |
dc.publisher | BMJ | en_US |
dc.rights | 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/. | - |
dc.rights.uri | https://creativecommons.org/licenses/by-nc/4.0/ | - |
dc.title | Imminent death: Clinician certainty and accuracy of prognostic predictions | en_US |
dc.type | Article | en_US |
dc.identifier.doi | https://doi.org/10.1136/bmjspcare-2018-001761 | - |
dc.relation.isPartOf | BMJ Supportive and Palliative Care | - |
pubs.issue | e6 | - |
pubs.publication-status | Published | - |
pubs.volume | 12 | - |
dc.identifier.eissn | 2045-4368 | - |
Appears in Collections: | Dept of Health Sciences Research Papers |
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