Temporal, Probabilistic and Surprise Question Approaches of Clinician Predicted Survival in Advanced Hepatopancreaticobiliary Cancers: A Prospective Cohort Study.

Objectives: Clinician-predicted survival for patients with hepatopancreaticobiliary cancers referred for specialist palliative care (SPC) has not been established. This study aimed to estimate and compare the three approaches of clinician predicted survival- temporal, probabilistic and surprise question (SQ) approaches at 7, 30, 60 and 90 days. Materials and Methods: A prospective observational study was conducted following ethical approval, involving 160 adult patients with metastatic cancers of the liver, pancreas, gallbladder and biliary system, who were not receiving any cancer-directed treatment and were referred to SPC from September 2022 to May 2023. Patients were prospectively followed up for 90 days. Results: A total of 160 patients were recruited, 134 (83.8%) of whom died by the end of the study period. The overall accuracy (OA) for the 7-day temporal, categorical and SQ approaches of Clinician Predicted Survival were 83.5%, 65.4% and 89.5%, respectively, whereas the 90-day OA was 86.5%, 86.3% and 93.4%, respectively. The c-statistic value for 60- and 90-day was 0.62 (95% confidence interval [CI]: 0.52-0.72) and 0.73 (95% CI: 0.60-0.86). Conclusion: The SQ approach was more accurate than the temporal and probabilistic approaches at all timepoints, in our study of patients with advanced hepatopancreaticobiliary cancers. The temporal approach displayed significantly moderate diagnostic accuracy on days 60 and 90. The least accurate prognostic estimation was recorded on day 30 for all three approaches. We further emphasise employing SQ as the preferred approach for determining the Clinician Predicted Survival.