Validation of a Palliative Prognostic Index to Predict Life Expectancy for Terminally Ill Cancer Patients in a Hospice Consultation Setting in Taiwan

Abstract

<b>Background:</b> The aim of our study was to assess the practical utility of the palliative prognostic index (PPI)as a prognostic tool used by nurse specialists in a hospice consultation setting in Taiwan. <br/><b>Methods</b>: In total, 623terminal cancer patients under hospice consultation care from one medical center in northern Taiwan wereenrolled between January 1 and June 30, 2011. PPI was assessed by a nurse specialist at first hospice consultationand patients categorized into groups by prognosis (good, intermediate, poor). Patient survival was analyzedretrospectively to determine significance of between-group differences. <br/><b>Results</b>: By PPI sum score, 37.2% ofpatients were in the good prognosis group, 18% in the intermediate prognosis group and 44.8% in the poorprognosis group. The death rates were 56%, 81.2% and 89.6% and median survivals were 76, 18 and 7 days,respectively. The hazard ratio was 0.19 (95% confidence interval [CI] 0.10-0.24, p<0.001) for the poor versusgood prognosis group and 0.54 (95% CI 0.43-0.69, p<0.001) for the poor versus intermediate prognosis group.The sensitivity and specificity for the poor prognosis group was 66% and 71%; the positive predictive value andnegative predictive value were 81% and 52%, respectively, to predict patient death within 21 days (area underthe curve of the receiver operating characteristic was 0.68). <br/><b>Conclusions</b>: Assessment by PPI can accuratelypredict survival of terminal cancer patients receiving hospice consultation care. PPI is a simple tool and can beadministered by nurse members of hospice consultation teams.