Assessing prognostic documentation and accuracy among palliative care clinicians

Area of Science:

• Palliative Care Medicine
• Medical Informatics
• Biostatistics

Background:

• Prognostication is crucial in palliative care, yet clinician survival estimates are often inaccurate.
• Limited research exists on palliative care providers' documentation and accuracy of survival estimates.

Purpose of the Study:

• To assess if palliative care clinicians document specific survival estimates in electronic medical records.
• To evaluate the accuracy of these documented survival estimates.

Main Methods:

• Retrospective analysis of 400 new palliative care consults (Oct 2009 - Dec 2010).
• Descriptive statistics used for demographics, survival, and documented estimates.
• Weighted kappa coefficients and Kaplan-Meier estimators assessed agreement.

Main Results:

• 69.4% of patients had documented survival estimates; 42.6% died within the estimated timeframe.
• Fair to moderate agreement between estimated and actual survival.
• Shorter prognosis groups had more accurate estimates; cancer patients showed least agreement.
• Overestimation was the most frequent error; template use increased documentation.

Conclusions:

• Palliative care physicians' prognostic accuracy is comparable to other clinicians.
• Survival overestimation is a consistent trend in prognostic research.
• Electronic medical record (EMR) templates enhance documentation of estimated prognosis.