Predicting life span for applicants to inpatient hospice

Area of Science:

• Palliative Care
• Medical Prognosis
• Health Services Research

Background:

• Hospice program eligibility and Medicare funding often depend on patient life expectancy predictions (typically <3 or 6 months).
• Accurate life span estimation by healthcare professionals is a critical, yet often unverified, assumption underlying hospice access.

Purpose of the Study:

• To evaluate the accuracy of expert predictions of patient life spans for hospice eligibility.
• To identify factors influencing prognostication accuracy and explore methods for improving survival predictions.

Main Methods:

• 108 inpatient hospice care applicants' life spans were prospectively followed until death.
• Independent life span predictions were made by oncologists, an internist, an oncology nurse, and a social worker using multidisciplinary application data.
• Actual survival times were correlated with expert predictions.

Main Results:

• The median actual life span was 3.5 +/- 12.4 weeks.
• Predictions were, on average, overly optimistic by 3.4 weeks.
• The best individual prognostication showed only moderate correlation with actual survival; predictions between experts showed poor correlation.
• Predicting the exact interval to death was more accurate than predicting a confidence interval, though confidence intervals better identified long-term survivors.

Conclusions:

• Imprecision in expert life span estimation presents significant challenges for hospice programs and healthcare policy.
• Current methods for predicting terminal illness duration require improvement to ensure equitable access to hospice care and effective resource allocation.