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  • How accurate is clinical prognostication by oncologists during routine practice in a general hospital and can it be improved by a specific prognosis training programme: a prospective interventional study

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Oncology
Original research
How accurate is clinical prognostication by oncologists during routine practice in a general hospital and can it be improved by a specific prognosis training programme: a prospective interventional study
  1. Irma Kupf1,
  2. Gabriele Thanner2,
  3. Michael Gerken3,
  4. Alexander Crispin4,
  5. Jan Braess5
  1. 1 Department of Dermatology and Allergy, Ludwig-Maximilians-Universität München, München, Germany
  2. 2 Pepig Gabriele Thanner MS Office and project management consulting, Neutraubling, Germany
  3. 3 Tumor Center, Centre for Quality Management and Health Services Research, University of Regensburg, Regensburg, Germany
  4. 4 Institute for Medical Information Processing, Biometry, and Epidemiology, Pettenkofer School of Public Health, Medical Faculty, Ludwig-Maximilians-Universität München, München, Germany
  5. 5 Department of Oncology and Hematology, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Germany
  1. Correspondence to Professor Jan Braess; Jan.Braess{at}barmherzige-regensburg.de

Abstract

Objectives Oncologists need competence in clinical prognostication to deliver appropriate care to patients with cancer. Most studies on prognostication have been restricted to patients in palliative care settings. This paper investigates (1) the prognostic accuracy of physicians regarding a broad cohort of patients with cancer with a median life expectancy of >2 years and (2) whether a prognosis training can improve prognostication.

Design Prospective single-centre study comprising 3 phases, each lasting 1 month.

Setting Large teaching hospital, department of oncology and haematology, Germany.

Participants 18 physicians with a professional experience from entry level to 34 years. 736 patients with oncological and malignant haematological diseases.

Interventions Baseline prognostication abilities were recorded during an ‘untrained’ phase 1. As an intervention, a specific prognosis-training programme was implemented prior to phases 2 and 3. In phase 3, physicians had to provide additional estimates with the inclusion of electronic prognostic tools.

Outcome measures Prognostic estimates (PE) were collected using ‘standard’ surprise question (SQ), ‘probabilistic’ SQ (both for short-term prognostication up to 6 months) and clinician prediction of survival (CPS) (for long-term prognostication). Estimated prognoses were compared with observed survival. Phase 1 was compared with phases 2 and 3.

Results We included 2427 PE for SQ, 1506 for CPS and 800 for probabilistic SQ. Median OS was 2.5 years. SQ accuracy improved significantly (p<0.001) from 72.6% in phase 1 to 84.3% in phase 3. Probabilistic SQ in phase 3 showed 83.1% accuracy. CPS accuracy was 25.9% and could not be significantly improved. (Electronic) prognostic tools—used alone—performed significantly worse (p<0.0005) than physicians and—used by the clinicians—did not improve their performance.

Conclusion A specific prognosis-training programme could improve short-term and intermediate-term prognostication. Improvement of long-term prognostication was not possible. Inexperienced residents as well as experienced oncologists benefited from training.

  • oncology
  • education & training (see medical education & training)
  • prognosis

Data availability statement

Data are available on reasonable request.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2023-081661

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    Data availability statement

    Data are available on reasonable request.

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    Footnotes

    • Contributors IK, JB and GT: design and analysis of the study. IK: data collection. IK and JB: writing of the manuscript. MG: provision of survival data. IK and AC: statistical analysis. IK, GT, MG, AC and JB: critical revision of the manuscript. All authors read and approved the final manuscript. IK is the guarantor of the study.

    • Funding This study was completely funded by the hospital Barmherzige Brüder Regensburg.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.