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Cited by 37Palliative Care and End-of-Life IssuesInsurance, Mortality, Demography, Risk ManagementClinical Reasoning and Diagnostic Skills

How accurate are doctors, nurses and medical students at predicting life expectancy

Clarke, Michael G., Ewings, P., Hanna, T., Dunn, L., Girling, T., Widdison, A.L.·2009·European Journal of Internal Medicine
DOI 10.1016/j.ejim.2009.06.009
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Abstract

Background Predicted patient life expectancy, based on a patient's medical history, is an important component of medical decision making. This study therefore aimed to determine the consistency, accuracy and precision with which doctors, nurses and medical students predict life expectancy (LE).Methods 20 doctors, 20 nurses and 20 medical students (4th and 5th year) independently examined 70 hypothetical patient case scenarios containing age, sex and comorbidity; this included 13 duplicate scenarios. Accuracy and consistency of prediction was assessed by comparison with statistical LE estimates generated using evidence-based actuarial and life insurance industry methods in collaboration with a team of professional actuaries.Results Doctors, nurses and medical students underestimated LE by a mean (95% confidence interval) of -1.46 (-0.31 to -2.61), -1.79 (-0.52 to -3.06) and -2.24 (-1.16 to -3.32) years with an equivalent root mean squared error (RMSE) of 4.74, 5.49 and 5.08 years respectively. LE predictions were equal to actuarial LE in less than 10% of cases and accurate to within 25% of actuarial LE in less than 45% of cases. Intra-observer reliability was 91%, 85% and 87% for doctors, nurses and medical students respectively. Inter-observer reliability was 66%, 57% and 57% for the three groups.Conclusion Doctors, nurses and medical students were inconsistent, inaccurate and imprecise in their prediction of LE with a tendency toward underestimation. This may lead to patients being managed inappropriately. There is a need for improved training and objective outcome prediction models.

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  • Studies suggest clinicians are routinely inconsistent, inaccurate, and imprecise in their prognostic estimations of life expectancy, with a tendency toward underestimation.

    “Studies suggest clinicians are routinely inconsistent, inaccurate, and imprecise in their prognostic estimations of life expectancy, with a tendency toward underestimation (22).”

    From Assisted death in eating disorders: a systematic review of cases and clinical rationales (2024) · cites this paper as [22]

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Authors
Clarke, M. G., Ewings, P., Hanna, T., Dunn, L., Girling, T., & Widdison, A. L.
Affiliations
  • Derriford Hospital (GB)
  • Musgrove Park Hospital (GB)
  • Royal Cornwall Hospital Trust (GB)
  • Peninsula College of Medicine and Dentistry (GB)
Corresponding author
Widdison, A.L.
ORCID
Venue
European Journal of Internal Medicine
Publisher
Elsevier BV
Published
2009-10
Volume
20
Issue
6
Pages
640-644
ISSN
0953-6205 (ISSN-L)
DOI
10.1016/j.ejim.2009.06.009
OpenAlex
W2084421592
Cited by
37
References
33
Citations by year
2026: 1 · 2025: 1 · 2024: 4 · 2023: 1 · 2022: 3 · 2021: 1 · 2020: 3 · 2019: 3 · 2018: 1 · 2017: 2 · 2016: 2 · 2015: 3 · 2014: 4 · 2013: 2 · 2012: 4
FWCI
2.01
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • European Journal of Internal Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
  • Social Sciences › Demography › Insurance, Mortality, Demography, Risk Management
  • Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
Keywords
life expectancy prediction, physician judgment, nurses, medical students, underestimation, prediction accuracy, inter-rater reliability, comorbidities, clinical decision-making, outcome prediction model
MeSH terms
Forecasting, Humans, Life Expectancy, Nurses, Physicians, Students, Medical, Reproducibility of Results, Observer Variation

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