The Prognosis in Palliative care Study II (PiPS2)

Record ID 32016000693
Authors' objectives: The term prognosis usually relates to the ability of clinicians to predict how long patients will survive. Doctors estimates are not very accurate. We developed the Prognosis in Palliative care Scales (PiPS) in order to predict survival in patients with advanced cancer no longer undergoing treatment. In our original study the PiPS was significantly more accurate than either a doctor's or a nurse's best guess about length of survival. Two different PiPS scores can be calculated (PIPS-A and PiPS-B), using routine clinical information (e.g. symptom scores and an assessment of overall health) with or without a blood test (depending upon whether the patient is competent to agree to providing one). Before we can recommend PiPS for routine use it is important to check that the scores remain as accurate and reliable as our original study suggested. PiPS is not the only way to predict survival. Four other scores may also be useful and need to be tested: the Palliative Prognostic Index (PPI) and the Palliative Performance Scale (PPS) can both be calculated without the need for a blood test (like PiPS-A); the Palliative Prognostic (PaP) score and the Feliu Prognostic Nomogram (FPN) both require blood results (like PiPS-B). The primary aims of our study is to check that PiPS is still accurate when we use it in a different group of cancer patients and to compare its accuracy against clinicians best guesses about how long patients are likely to survive. We will also look at the performance of other prognostic scores; PaP, FPN, PPI and PPS. We will do this by asking patients with advanced incurable cancer, who have recently been referred to palliative ( hospice ) care services, to take part in our study. If patients are able to make a decision for themselves then, with their approval, we will collect information about them from their medical notes and we will take a blood test. If patients are unable to make a decision for themselves (because for instance they are unconscious or delirious), then we will ask their relatives for permission to record information from their medical notes. We will not take blood tests from patients who cannot give permission. With this information we will be able to calculate PiPS, PaP, FPN, PPI & PPS scores. When patients die we will be able to work out the accuracy of the various predictions. We will need to include 1,361 patients over a three year period from 38 different services before we are able to judge whether or not PiPS is valid and better than clinician estimates. In addition to this we will also be asking a selected sample of patients, carers and clinicians about the acceptability of relying on clinicians best guesses about survival or the use of one or other of the prognostic tools. We will audio-record and analyse these interviews in order to look for common themes. This information will help us to decide which method of predicting survival is most likely to be used in day-today practice and what is the best way to present this information to patients. Our research team is made up of doctors and scientists who have a lot of experience with undertaking this type of study. Three of the researchers were involved in the original study which developed the PiPS. We will also be working with patient and carer representatives and with researchers from other countries who developed other prognostic scores (PaP, FPN and PPI).
Project Status: Ongoing
Anticipated Publish Date: 2021
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: England, United Kingdom
MeSH Terms
  • Terminal Care
  • Hematologic Tests
  • Neoplasms
  • Palliative Care
  • Prognosis
Organisation Name: NIHR Health Technology Assessment programme
Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK
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