Accuracy of clinician perceptions in estimating patient survival in general medicine

BACKGROUND: Patients and families often rely on clinicians' predictions of life expectancy to make critical treatment and personal decisions. AIM: To evaluate the accuracy and risk intelligence of clinicians in predicting 1-year survival of general medicine patients after hospital discharge. METHODS: Doctors, nurses, allied health professionals and medical students completed 125 questionnaires (70% response rate) distributed in the intensive care unit (ICU) and at a medical grand round at Christchurch Hospital. Survival estimates for four case vignettes were compared to an evidence-based survival score (EBSS) derived from over 120 000 local hospital discharges. Accuracy was defined as estimates within ±10% and ±20% of the EBSS. Confidence was assessed based on the reported range for each estimate. RESULTS: Median survival estimates were widely variable and frequently underestimated the EBSS, with 27% and 48% of estimates falling within ±10% and ±20% of the EBSS respectively. Confidence was moderate (median range ±15%), although 52% of estimates were outside ±20% of the EBSS. No significant differences in accuracy were observed between ICU and general medicine respondents, doctors and other healthcare professionals, or senior and junior doctors. CONCLUSIONS: Clinician estimates of 1-year survival in vignette-based scenarios varied widely and differed from model-based estimates. These findings highlight variability in prognostic estimation and support the potential role of evidence-based tools to complement clinical judgement.