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Abstract：
OBJECTIVE: 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.
METHODS: Prospective single-centre study comprising 3 phases, each lasting 1 month.
METHODS: Large teaching hospital, department of oncology and haematology, Germany.
METHODS: 18 physicians with a professional experience from entry level to 34 years. 736 patients with oncological and malignant haematological diseases.
METHODS: 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.
METHODS: 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.
CONCLUSIONS: 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.
METHODS: Prospective single-centre study comprising 3 phases, each lasting 1 month.
METHODS: Large teaching hospital, department of oncology and haematology, Germany.
METHODS: 18 physicians with a professional experience from entry level to 34 years. 736 patients with oncological and malignant haematological diseases.
METHODS: 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.
METHODS: 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.
CONCLUSIONS: 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.
摘要：
目的：肿瘤学家需要临床预后的能力来为癌症患者提供适当的治疗。大多数关于预后的研究仅限于姑息治疗环境中的患者。本文研究了（1）医生对中位预期寿命>2年的癌症患者的广泛队列的预后准确性，以及（2）预后训练是否可以改善预后。
方法：前瞻性单中心研究，包括3个阶段，每次持续1个月。
方法：大型教学医院，肿瘤和血液科，德国。
方法：18名具有从入门级到34年专业经验的医生。736例肿瘤和恶性血液病患者。
方法：在“未训练”阶段1记录基线预测能力。作为一种干预,在第2阶段和第3阶段之前实施了具体的预后培训计划.在第3阶段，医生必须提供额外的估计，包括电子预后工具。
方法：使用“标准”惊喜问题（SQ）收集预后估计（PE），概率SQ（短期预测长达6个月）和临床医生生存预测（CPS）（长期预测）。将估计的预后与观察到的生存率进行比较。将阶段1与阶段2和阶段3进行比较。
结果：我们包括了SQ的2427PE，1506用于CPS，800用于概率SQ。OS中位数为2.5年。SQ准确度显著提高(p<0.001),从第1阶段的72.6%提高到第3阶段的84.3%。第3阶段的概率SQ显示出83.1%的准确率。CPS准确率为25.9%，不能明显提高。（电子）预后工具-单独使用-比医生明显更差（p<0.0005），并被临床医生使用-并没有提高他们的表现。
结论：特定的预后训练计划可以改善短期和中期预后。长期预测的改善是不可能的。没有经验的居民以及有经验的肿瘤学家从培训中受益。
方法：前瞻性单中心研究，包括3个阶段，每次持续1个月。
方法：大型教学医院，肿瘤和血液科，德国。
方法：18名具有从入门级到34年专业经验的医生。736例肿瘤和恶性血液病患者。
方法：在“未训练”阶段1记录基线预测能力。作为一种干预,在第2阶段和第3阶段之前实施了具体的预后培训计划.在第3阶段，医生必须提供额外的估计，包括电子预后工具。
方法：使用“标准”惊喜问题（SQ）收集预后估计（PE），概率SQ（短期预测长达6个月）和临床医生生存预测（CPS）（长期预测）。将估计的预后与观察到的生存率进行比较。将阶段1与阶段2和阶段3进行比较。
结果：我们包括了SQ的2427PE，1506用于CPS，800用于概率SQ。OS中位数为2.5年。SQ准确度显著提高(p<0.001),从第1阶段的72.6%提高到第3阶段的84.3%。第3阶段的概率SQ显示出83.1%的准确率。CPS准确率为25.9%，不能明显提高。（电子）预后工具-单独使用-比医生明显更差（p<0.0005），并被临床医生使用-并没有提高他们的表现。
结论：特定的预后训练计划可以改善短期和中期预后。长期预测的改善是不可能的。没有经验的居民以及有经验的肿瘤学家从培训中受益。
