A qualitative analysis of the elements used by palliative care clinicians when formulating a survival estimate. Issue 3 (30th November 2012)

• Record Type: Journal Article
• Authors: Clarkson, Rose; Selby, Debbie; Myers, Jeff
• Is Part Of: BMJ supportive & palliative care. Volume 3:Issue 3(2013)
• Page Start: 330
• Page End: 334
• Publication Date: 2012-11-30
• Subjects: Prognosis -- Hospice care -- Palliative Care -- Survival Estimation; Palliative treatment -- Periodicals; Terminal care -- Periodicals; 616.029
• DOI: 10.1136/bmjspcare-2012-000320
• Languages: English
• ISSNs: 2045-435X

Abstract

Abstract : Objective: For patients with advanced and/or incurable disease, clinicians are often called upon to formulate and communicate an estimate of likely survival duration. The objective of this study was to gain a deeper appreciation of this process by identifying and exploring the specific elements that may inform and/or impact a clinician's estimate of survival (CES). Methods: Semistructured interviews were conducted among a group of palliative care clinicians in the setting of a tertiary academic health sciences centre. Qualitative data were subsequently analysed using a grounded theory approach. Results: Five major themes were identified as being central to the process of CES formulation: use of objective patient-specific elements, strength of the patient-clinician relationship, purpose and context of an individual CES, perceived role of hope and the overall likelihood of CES inaccuracy. Conclusions: For any given patient, several elements have the potential to inform and/or impact the process of CES formulation. Study participants were aware of objective clinical factors known to correlate with actual survival duration and likely integrate this information when formulating a CES. Formulation occurs within a larger context comprised of a number of elements that may influence individual estimates. These elements exist against a background of awareness of the overall likelihood of CES inaccuracy. Clinicians are encouraged to develop a personalised and standardised approach to CES formulation whereby an awareness of the menu of potentially impacting elements is consciously integrated into an individual process.