About the “surprise question”

Costantini, Massimo; Higginson, Irene J; Merlo, Domenico Franco; Leo, Silvia Di; Tanzi, Silvia

doi:10.1503/cmaj.733083

Cited by 7 publications

(6 citation statements)

References 8 publications

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“…A filtering process focusing on the patient's context, which includes symptom control in comparison to closeness to death may be better in indicating who needs a SIC. 32,34…”

Section: Filtering Processmentioning

confidence: 99%

The Surprise Question and Serious Illness Conversations: A pilot study

Le¹,

Lee

Desai

et al. 2021

Nurs Ethics

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Background: Serious Illness Conversations aim to discuss patient goals. However, on acute medicine units, seriously ill patients may undergo distressing interventions until death. Objectives: To investigate the feasibility of using the Surprise Question, “Would you be surprised if this patient died within the next year?” to identify patients who would benefit from early Serious Illness Conversations and study any changes in the interdisciplinary team’s beliefs, confidence, and engagement as a result of asking the Surprise Question. Design: A prospective cohort pilot study with two Plan-Do-Study-Act cycles. Participants/context: Fifty-eight healthcare professionals working on Acute Medicine Units participated in pre- and post-intervention questionnaires. The intervention involved asking participants the Surprise Question for each patient. Patient charts were reviewed for Serious Illness Conversation documentation. Ethical considerations: Ethical approval was granted by the institutions involved. Findings: Equivocal overall changes in the beliefs, confidence, and engagement of healthcare professionals were observed. Six out of 23 patients were indicated as needing a Serious Illness Conversation; chart review provided some evidence that these patients had more Serious Illness Conversation documentation compared with the 17 patients not flagged for a Serious Illness Conversation. Issues were identified in equating the Surprise Question to a Serious Illness Conversation. Discussion: Appropriate support for seriously ill patients is both a nursing professional and ethical duty. Flagging patients for conversations may act as a filtering process, allowing healthcare professionals to focus on conversations with patients who need them most. There are ethical and practical issues as to what constitutes a “serious illness” and if answering “no” to the Surprise Question always equates to a conversation. Conclusion: The barriers of time constraints and lack of training call for institutional change in order to prioritise the moral obligation of Serious Illness Conversations.

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“…A filtering process focusing on the patient's context, which includes symptom control in comparison to closeness to death may be better in indicating who needs a SIC. 32,34…”

Section: Filtering Processmentioning

confidence: 99%

The Surprise Question and Serious Illness Conversations: A pilot study

Le¹,

Lee

Desai

et al. 2021

Nurs Ethics

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“…It may be the case that patients diagnosed with malignancies exhibit a more predictable and consistent disease progression compared with those with other chronic conditions such as heart failure or chronic respiratory disease, where disease trajectories often display greater variability and unpredictability. 68 When studies were divided by timeframe, the rate of identifying patients that were dying were similar (sensitivity <1 year=0.69 (0.56 to 0.82) I 2 =99.3%; 1 year=0.68 (0.63 to 0.74) I 2 =95.0%; >1 year=0.71 (0.60 to 0.82) I 2 =93.4%). A prior meta-analysis found that there were no differences in the accuracy of the Surprise Question when study timeframes shorter than 1 year were included, although in a limited sample of studies.…”

Section: Discussionmentioning

confidence: 94%

The Surprise Question and clinician-predicted prognosis: systematic review and meta-analysis

Gupta,

Burgess,

Drozd

et al. 2024

BMJ Support Palliat Care

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BackgroundThe Surprise Question, ‘Would you be surprised if this person died within the next year?’ is a simple tool that can be used by clinicians to identify people within the last year of life. This review aimed to determine the accuracy of this assessment, across different healthcare settings, specialties, follow-up periods and respondents.MethodsSearches were conducted of Medline, Embase, AMED, PubMed and the Cochrane Central Register of Controlled Trials, from inception until 01 January 2024. Studies were included if they reported original data on the ability of the Surprise Question to predict survival. For each study (including subgroups), sensitivity, specificity, positive and negative predictive values and accuracy were determined.ResultsOur dataset comprised 56 distinct cohorts, including 68 829 patients. In a pooled analysis, the sensitivity of the Surprise Question was 0.69 ((0.64 to 0.74) I2=97.2%), specificity 0.69 ((0.63 to 0.74) I2=99.7%), positive predictive value 0.40 ((0.35 to 0.45) I2=99.4%), negative predictive value 0.89 ((0.87 to 0.91) I2=99.7%) and accuracy 0.71 ((0.68 to 0.75) I2=99.3%). The prompt performed best in populations with high event rates, shorter timeframes and when posed to more experienced respondents.ConclusionsThe Surprise Question demonstrated modest accuracy with considerable heterogeneity across the population to which it was applied and to whom it was posed. Prospective studies should test whether the prompt can facilitate timely access to palliative care services, as originally envisioned.PROSPERO registration numberCRD32022298236.

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“…Failure to adequately estimate such patients' prognosis may lead to a delay in communication and in identifying patients' values and wishes for subsequent treatment, which may include a preference for palliative care instead of or alongside other therapies (Moss et al, 2010)|. However, as stated by Costantini et al (2017), prognosis (alone) should not be the driver for referral to palliative care: assessment of the physical, social, psychological and spiritual needs of the patient are crucial (Costantini et al, 2017). The SQ can be used as a tool to ensure that patients who are at the end of life and who can benefit from (specialist) palliative care are identified in a timely manner.…”

Section: Discussionmentioning

confidence: 99%

“…However, as stated by Costantini et al (2017), prognosis (alone) should not be the driver for referral to palliative care: assessment of the physical, social, psychological and spiritual needs of the patient are crucial (Costantini et al, 2017). The SQ can be used as a tool to ensure that patients who are at the end of life and who can benefit from (specialist) palliative care are identified in a timely manner.…”

Section: Prognostic Value Of the Sqsmentioning

confidence: 99%

The prognostic value of the 12‐, 6‐, 3‐ and 1‐month ‘Surprise Question’ in cancer patients: A prospective cohort study in three hospitals

Brinkman-Stoppelenburg

Arslan

Owusuaa

et al. 2022

European J Cancer Care

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Objective: This prospective study aimed to evaluate the performance of the 'Surprise Question' (SQ) 'Would I be surprised if this patient died in the next 12 months?' in predicting survival of 12, 6, 3 and 1 month(s), respectively, in hospitalised patients with cancer.Methods: In three hospitals, physicians were asked to answer SQs for 12/6/3/1 month(s) for inpatients with cancer. Sensitivity, specificity, positive and negative predictive values were calculated.Results: A total of 783 patients were included, of whom 51% died in the 12-month period after inclusion. Sensitivity of the SQ predicting death within 12 months was 0.79, specificity was 0.66, the positive predictive value was 0.71 and the negative predictive value was 0.75. When the SQ concerned a shorter survival period, sensitivities and positive predictive values decreased, whereas specificities and negative predictive values increased. In multivariable logistic regression analysis, the SQ was significantly associated with mortality (OR 3.93, 95% CI 2.70-5.71, p < 0.01). Conclusions:The 12-month SQ predicts death in patients with cancer admitted to the hospital reasonably well. Shortening the timeframe decreases sensitivities and increases specificities. The four surprise questions may help to identify patients for whom palliative care is indicated.

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About the “surprise question”

Cited by 7 publications

References 8 publications

The Surprise Question and Serious Illness Conversations: A pilot study

The Surprise Question and Serious Illness Conversations: A pilot study

The Surprise Question and clinician-predicted prognosis: systematic review and meta-analysis

The prognostic value of the 12‐, 6‐, 3‐ and 1‐month ‘Surprise Question’ in cancer patients: A prospective cohort study in three hospitals

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