Performance of clinical judgment and prognostic scales for survival prediction in palliative care: A prospective cohort study

Background: Accurate survival estimation is essential for decision-making in advanced cancer care. However, clinical judgment alone often tends to overestimate survival. The performance of prognostic tools has scarcely been explored in Latin American populations. Objectives: To prospectively evaluate and compare the predictive performance of four prognostic scales: the Palliative Prognostic Index, the Performance Status-Palliative Prognostic Index, the Palliative Prognostic Score, and the Delirium-Palliative Prognostic Score, against the clinical judgment of specialists in a Colombian cohort. Design: An observational, analytical, prospective cohort study was conducted. Methods: The study included 166 patients with advanced cancer admitted to a specialized Palliative Care Unit in Colombia. Participants were followed for up to 90 days or until death. We compared the discrimination of the scales using Harrell's Concordance Index (C-index) and area under the receiver operating characteristic curve at 7, 30, and 90 days. Calibration was assessed using calibration plots. Results: Specialist clinical judgment, the Palliative Prognostic Score, and the Delirium-Palliative Prognostic Score demonstrated excellent discriminatory capacity for short-term survival prediction, with a concordance index greater than 0.8. Clinical judgment tended to underestimate 7-day survival, while all tools showed a tendency to overestimate 90-day survival. A high short-term mortality rate was observed, with nearly 50% of patients dying within 30 days of admission. Conclusion: In specialized palliative care settings in Latin America, combining expert clinical judgment with the Palliative Prognostic Score or its delirium variant is recommended for prognostication. The Palliative Prognostic Index and its performance status-based variant are useful alternatives in nonspecialized settings. The high short-term mortality observed highlights a systemic issue of late referral to palliative care services in the region.