Specialist Palliative Care Team ABM ULHB 6th November 2009 Palliative Prognositic Index - Hospital Palliative Care Team’s Experience Specialist Palliative Care Team ABM ULHB 6th November 2009

Audit of HPCT Accuracy of Prediction of Survival Background Importance achieving preferred priorities of care Exploration of role in rapid discharge

Method First assessment of every patient referred to HPCT over 5 weeks Prediction of survival Less than 1 week Between 1 and 3 weeks Between 3 and 6 weeks More than 6 weeks Date of assessment Date of death

Accuracy of prediction of survival less than 3 weeks Positive predictive value – of the patients we predicted to survive less than 3 weeks, how many did die within the first 3 weeks Negative predictive value – of the patients we predicted to survive more than 3 weeks, how many were still alive at 3 weeks Sensitivity – of all the patients who died within the first 3 weeks, how many had we predicted would survive less than three weeks Specificity – of all the patients who were alive at 3 weeks, how many had we predicted to survive more than 3 weeks

Audit Standard Accuracy of prediction of survival less than 3 week Positive Predictive Value – 83% Negative Predictive Value – 65% Sensitivity – 68% Specificity – 68%

Clinical Prediction of Survival Results

47 patients Median survival until June 23rd – 21 days Prediction Actual survival

Survival curve of CPS groups

Comparison of CPS and actual survival

Accuracy of CPS predicting survival of less than 3 weeks HPCT CPS Standard PPV 88 83 NPV 63 65 Sensitivity 58 68 Specificity 90 PPI Stone et al PPI Morita et al 86% 80% 76% 87% 56% 83% 94% 85%    

Palliative Prognostic Index Developed Japan 1999 Assessment of clinical symptoms No invasive tests Time scales Three and six weeks

Palliative Prognostic Index Items Palliative Performance Scale Oral intake Oedema Dyspnoea at rest Delirium Scores 4, 2.5, 0 2.5, 1, 0 1, 0 3.5, 0 4, 0 PPI total score >6 = suggests survival of less than 3 weeks

CPS and PPI results

Comparison of patient survival between the two cycles

50 patients Predicted survival Actual survival

Survival of the two groups

CPS and PPI prediction of survival of less than 3 weeks

Accuracy of CPS + PPI     PPV 68 83 Sensitivity 76 HPCT CPS Standard PPV 68 83 NPV 73 65 Sensitivity 76 Specificity 94    

Conclusion The HPCT will not routinely use the Palliative Prognostic Index to estimate patient survival

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