Cancer treatment involves a multidisciplinary approach, with both physicians and nurses playing crucial roles in patient care. One key aspect of patient assessment is the Eastern Cooperative Oncology Group Performance Status (ECOG-PS) scale, which helps predict clinical outcomes and guide treatment decisions. However, there has been a debate about whether physician or nurse ratings of ECOG-PS scores are more reliable in predicting these outcomes.
A recent retrospective cohort study aimed to compare the predictive abilities of physician and nurse ECOG-PS ratings in patients receiving chemotherapy for cancer. The study also investigated the impact of discrepancies in ratings between physicians and nurses.
Physician vs. Nurse ECOG-PS Ratings
The study involved 32 oncologists and 41 chemotherapy nurses who independently rated ECOG-PS scores for 311 cancer patients over a 19-month period. Logistic regression models were then used to evaluate the ability of physician and nurse ECOG-PS scores to predict chemotherapy toxicity, hospitalizations, and 6-month mortality or hospice referrals.
The results showed that there was a 71% agreement between physician and nurse ECOG-PS ratings, indicating moderate concordance. Nurse ECOG-PS scores had a stronger association with 6-month mortality or hospice referrals compared to physician ratings. Additionally, nurse ratings, but not physician ratings, correlated with 1-month chemotherapy toxicity and hospitalizations.
Discrepancies Between Physicians and Nurses
The study also examined the impact of discrepancies in ECOG-PS ratings between physicians and nurses. It was found that nurse-physician disagreements, particularly when physicians gave “healthier” (lower) ratings, were associated with worse outcomes. These disagreements were linked to increased chemotherapy toxicity, hospitalizations, and 6-month mortality or hospice referrals.
The Role of Nurse Ratings in Clinical Practice
The findings of this study suggest that nurse ratings of ECOG-PS scores may be more predictive of important clinical outcomes in cancer patients compared to physician ratings. The study highlights the potential benefits of incorporating nurse assessments into the decision-making process for patient care.
Nurse-rated ECOG-PS scores were found to better predict hospitalizations, severe chemotherapy toxicity within 1 month, and mortality or hospice referrals within 6 months. By involving nurses in the rating process, healthcare professionals can gain additional clinical insights and improve prognostication. This can lead to better-informed decisions regarding chemotherapy administration, the need for supportive care, and goals of care discussions.
FAQs
Q: What is the ECOG-PS scale?
The Eastern Cooperative Oncology Group Performance Status (ECOG-PS) scale is a widely used tool to assess the functional status and overall wellbeing of cancer patients. It helps predict clinical outcomes and guide treatment decisions.
Q: How do nurse ratings compare to physician ratings?
The study found that nurse ratings of ECOG-PS scores were more predictive of important outcomes such as hospitalizations, chemotherapy toxicity, and mortality or hospice referrals. Nurse-physician disagreements, particularly when physicians gave lower ratings, were associated with worse outcomes.
Q: What are the implications of this study for clinical practice?
Incorporating nurse assessments of ECOG-PS scores alongside physician ratings can provide additional clinical benefits. It can improve prognostication, enhance decision-making regarding chemotherapy administration and supportive care, and facilitate discussions about goals of care.
Conclusion
The study comparing physician and nurse ECOG-PS ratings provides valuable insights into the role of nurses in predicting clinical outcomes in cancer patients. Nurse ratings were found to be more predictive of important outcomes, and nurse-physician disagreements in ratings were associated with worse outcomes. These findings highlight the significance of incorporating nurse assessments into the decision-making process for cancer care. By doing so, healthcare professionals can improve patient prognostication and make more informed treatment decisions.