Accuracy Of Survival Prediction Instruments In Older Patients Undergoing Home-Based Palliative Care In Curitiba, Brazil

Abstract

INTRODUCTION: Prognostic scores are crucial to avoid unnecessary measures in palliative care, although their use in noncancer patients undergoing home care in low-income countries lacks evidence. OBJECTIVE: To compare the accuracy of the survival prediction instruments Palliative Performance Scale (PPS), Karnofsky Performance Status (KPS), Palliative Prognostic Index (PPI), and Palliative Prognostic Score (PaP) in the older population treated by a Home Care Service (HCS) program in Curitiba, southern Brazil. METHODS: This is a prospective, observational, diagnostic accuracy study evaluating older adults undergoing HCS-provided palliative care. PPS, The PPS, KPS, PaP, and PPI scores were administered, and after 90 days the patients were evaluated for the outcomes death and hospital admission. RESULTS: The final sample consisted of 53 patients aged ≥ 60 years; 28.3% (n = 15) of those had age ≥ 85 years. In the binary analysis, PaP had the best accuracy (79.2%). In the ordinal analysis, PPI had the best accuracy (58.5%), but all prognostic scales evaluated the sample similarly, with no significant differences. In both analyses, the patients aged ≥ 85 years had similar results compared to the total sample. Although the HCS program is a distinct setting, the study results were similar to those of studies conducted in hospices and hospitals. CONCLUSION: The prognostic scores showed better accuracy when predicting only the outcome death but are less accurate when admission is included. There was no superior scale neither any difference in accuracy regarding age range.

Keywords

• aged
• home care services
• palliative care
• palliative medicine
• prognosis
• survival