ArticlePloS one2021
Prognostic tools or clinical predictions: Which are better in palliative care?
Article in PloS one, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 24 papers, 4 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
24 citing papers in PubMed, 4 syntheses or guidelines pooled it, 49 citations in OpenAlex.
- A systematic review of the assessment model for palliative care needs in cancer patients.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2026Pooled it
- Prognostic models for survival predictions in advanced cancer patients: a systematic review and meta-analysis.BMC palliative care · 2025Pooled it
- Palliative prognostic scores for survival prediction of cancer patients: a systematic review and meta-analysis.Journal of the National Cancer Institute · 2024Pooled it
- Prognostic evaluation in patients with advanced cancer in the last months of life: ESMO Clinical Practice Guideline.ESMO open · 2023Guideline
- Integrating community services provision for older people living with severe frailty: implications from an England-wide survey.Age and ageing · 2025Article
- Associations of dyadic appraisal of cancer cachexia symptoms with psychological distress and quality of life in dyads of palliative care patients: a longitudinal mixed-methods study protocol.BMC palliative care · 2025Article
- Determining timeframes to death for imminently dying patients: a retrospective cohort study.BMC palliative care · 2025Article
- The impact of a web-based prognostic calculator on prognostic confidence in outpatient palliative care.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2024Article
- 'How long do you think?' Unresponsive dying patients in a specialist palliative care service: A consecutive cohort study.Palliative medicine · 2024Article
- Clinicians' Prediction of Survival Is Most Useful for Palliative Care Referral.Palliative medicine reports · 2024Article
- Accuracy of clinical predictions of prognosis at the end-of-life: evidence from routinely collected data in urgent care records.BMC palliative care · 2023Observational
- Article
- GC-MS Techniques Investigating Potential Biomarkers of Dying in the Last Weeks with Lung Cancer.International journal of molecular sciences · 2023Article
- Life-Sustaining Treatment Decision in Palliative Care Based on Electronic Health Records Analysis.Journal of clinical nursing · 2023Review
- Assisted suicide a 20The Ulster medical journal · 2023Article
- Clinical Features of Patients With Hematological Malignancies Treated at the Palliative Care Unit.Palliative medicine reports · 2023Article
- Exploring the Potential Use of Wearable Devices as a Prognostic Tool among Patients in Hospice Care.Medicina (Kaunas, Lithuania) · 2022Observational
- Development and Validation of the PaP Score Nomogram for Terminally Ill Cancer Patients.Cancers · 2022Article
- Article
- Development and validation of a novel nomogram to predict overall survival of patients with moderate to severe chronic kidney disease.Renal failure · 2022Article
Corrections and comments
- Erratum issued
Authors and funding
10 authors at 3 institutions in 1 country.
Funding
Abstract
purposeThe Palliative Prognostic (PaP) score; Palliative Prognostic Index (PPI); Feliu Prognostic Nomogram (FPN) and Palliative Performance Scale (PPS) have all been proposed as prognostic tools for palliative cancer care. However, clinical judgement remains the principal way by which palliative care professionals determine prognoses and it is important that the performance of prognostic tools is compared against clinical predictions of survival (CPS).
methodsThis was a multi-centre, cohort validation study of prognostic tools. Study participants were adults with advanced cancer receiving palliative care, with or without capacity to consent. Key prognostic data were collected at baseline, shortly after referral to palliative care services. CPS were obtained independently from a doctor and a nurse.
resultsPrognostic data were collected on 1833 participants. All prognostic tools showed acceptable discrimination and calibration, but none showed superiority to CPS. Both PaP and CPS were equally able to accurately categorise patients according to their risk of dying within 30 days. There was no difference in performance between CPS and FPN at stratifying patients according to their risk of dying at 15, 30 or 60 days. PPI was significantly (p<0.001) worse than CPS at predicting which patients would survive for 3 or 6 weeks. PPS and CPS were both able to discriminate palliative care patients into multiple iso-prognostic groups.
conclusionsAlthough four commonly used prognostic algorithms for palliative care generally showed good discrimination and calibration, none of them demonstrated superiority to CPS. Prognostic tools which are less accurate than CPS are of no clinical use. However, prognostic tools which perform similarly to CPS may have other advantages to recommend them for use in clinical practice (e.g. being more objective, more reproducible, acting as a second opinion or as an educational tool). Future studies should therefore assess the impact of prognostic tools on clinical practice and decision-making.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.