Nephrology Provider Surprise Question Response and Hospitalizations in Older Adults with Advanced CKD

Ramer, Sarah J.; Baddour, Nicolas; Siew, Edward D.; Salat, Huzaifah; Bian, Aihua; Stewart, Thomas G.; Wong, Susan; Jhamb, Manisha; Abdel-Kader, Khaled

doi:10.1159/000509046

Cited by 4 publications

(7 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Eligible patients will be identified using a clinical provider-initiated indicator, the surprise question (SQ): “would you be surprised if this patient died in the next 12 months?” [ 35 ]. The HPs may answer the question on a 5-point Likert scale (“definitely not surprised”, “not surprised”, “neutral”, “surprised” or “very surprised”) [ 36 ]. Patients who are cognitively unable to participate will be excluded from the research.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Shared decision-making and planning end-of-life care for patients with end-stage kidney disease: a protocol for developing and testing a complex intervention

Buur

Finderup

Søndergaard³

et al. 2022

Pilot Feasibility Stud

View full text Add to dashboard Cite

Background Internationally, it has been stressed that advance care planning integrated within kidney services can lead to more patients being involved in decisions for end-of-life care. In Denmark, there is no systematic approach to advance care planning and end-of-life care interventions within kidney services. A shared decision-making intervention for planning end-of-life care may support more effective treatment management between patients with end-stage kidney disease, their relatives and the health professionals. The purpose of this research is to find evidence to design a shared decision-making intervention and test its acceptability to patients with end-stage kidney disease, their relatives, and health professionals in Danish kidney services. Methods This research project will be conducted from November 2020 to November 2023 and is structured according to the UK Medical Research Council framework for complex intervention design and evaluation research. The development phase research includes mixed method surveys. First, a systematic literature review synthesising primary empirical evidence of patient-involvement interventions for patients with end-stage kidney disease making end-of-life care decisions will be conducted. Second, interview methods will be carried out with patients with end-stage kidney disease, relatives, and health professionals to identify experiences of involvement in decision-making and decisional needs when planning end-of-life care. Findings will inform the co-design of the shared decision-making intervention using an iterative process with our multiple-stakeholder steering committee. A pilot test across five kidney units assessing if the shared decision-making intervention is acceptable and feasible to patients, relatives, and health professionals providing services to support delivery of care in kidney services. Discussion This research will provide evidence informing the content and design of a shared decision-making intervention supporting patient-professional planning of end-of-life care for patients with end-stage kidney disease, and assessing its acceptability and feasibility when integrated within Danish kidney units. This research is the first step to innovating the involvement of patients in end-of-life care planning with kidney professionals.

show abstract

Section: Methodsmentioning

confidence: 99%

“…[35]. The HPs may answer the question on a 5-point Likert scale ("definitely not surprised", "not surprised", "neutral", "surprised" or "very surprised") [36].…”

Section: Recruitmentmentioning

confidence: 99%

Shared decision-making and planning end-of-life care for patients with end-stage kidney disease: a protocol for developing and testing a complex intervention

Buur

Finderup

Søndergaard³

et al. 2022

Pilot Feasibility Stud

View full text Add to dashboard Cite

show abstract

“…Patients designated by a negative answer to the surprise question are older, more frail have spent more time in the hospital, have more symptoms and have greater healthcare utilisation 9 1011 12.…”

Section: What Is Known?mentioning

confidence: 99%

The Surprise Question

Davis

Vanenkevort

2022

BMJ Support Palliat Care

View full text Add to dashboard Cite

“…24 Despite its limitations in prediction, the SQ is a simple way to prompt timelier goals of care discussions including advance care planning. 10,11,14,[16][17][18] Easy to use tools that prompt advance care planning have utility in nephrology settings in which physicians routinely cite a lack of time and competing priorities as reasons for not having goals-of-care discussions. 19 Interventions that promote goals-of-care discussions may help patients to match their values and preferences to treatment decisions, including whether to initiate dialysis or manage their kidney disease conservatively.…”

Section: Introductionmentioning

confidence: 99%

“…is a validated prognostication tool for mortality and hospitalization among patients with advanced CKD. [10][11][12][13][14][15] It can also be a useful screen for identifying frailty and disability in the older CKD patients. 11 Integration of SQ in the electronic health record (EHR) in the inpatient setting for other disease states has shown to be highly feasible, acceptable and facilitate advance care planning discussions.…”

Section: Introductionmentioning

confidence: 99%

Implementation of Surprise Question Assessments using the Electronic Health Record in Older Adults with Advanced CKD

et al. 2021

Self Cite

View full text Add to dashboard Cite

Background. The Surprise Question (SQ; "Would you be surprised if this patient died in the next 12 months?") is a validated prognostication tool for mortality and hospitalization among patients with advanced CKD. Barriers in clinical workflow have slowed SQ implementation into practice. Objectives. (1) To evaluate implementation outcomes following use of electronic health record (EHR) decision support to automate collection of the SQ. (2) To assess the prognostic utility of the SQ for mortality and hospitalization/emergency room (ER) visits. Methods. We developed and implemented a best practice alert (BPA) in the electronic health record (EHR) to identify nephrology outpatients > 60 years of age with an eGFR<30 ml/min. At appointment, the BPA prompted the physician to answer the SQ. We assessed the rate and timeliness of provider responses. We conducted a post-hoc open-ended survey to assess physician perceptions of SQ implementation. We assessed the SQ's prognostic utility in survival and time-to-hospital encounter (hospitalization/ER visit) analyses. Results. Among 510 patients for whom the BPA triggered, 95 (18.6%) had the SQ completed by 16 physicians. Among those completed, nearly all (97.9%) were on appointment day, and 61 (64.2%) the first time the BPA fired. Providers answered "No" for 27 (28.4%) and "Yes" for 68 (71.6%) patients. By 12 months, 6 (22.2%) "No" patients died; 3 (4.4%) "Yes" patients died (hazards ratio [HR] 2.86, ref:Yes, 95% CI[1.06, 7.69]). About 35% of "No" patients and 32% of "Yes" patients had a hospital encounter by 12 months (HR 1.85, ref:Yes, 95% CI[0.93, 3.69]). Physicians noted (1) they had goals-of-care conversations unprompted; (2) EHR-based interventions alone for goals-of-care are ineffective; and (3) more robust engagement is necessary. Conclusions. We successfully integrated the SQ into the EHR to aid in clinical practice. Additional implementation efforts are needed to encourage further integration of the SQ in clinical practice.

show abstract

Nephrology Provider Surprise Question Response and Hospitalizations in Older Adults with Advanced CKD

Cited by 4 publications

References 32 publications

Shared decision-making and planning end-of-life care for patients with end-stage kidney disease: a protocol for developing and testing a complex intervention

Shared decision-making and planning end-of-life care for patients with end-stage kidney disease: a protocol for developing and testing a complex intervention

The Surprise Question

Implementation of Surprise Question Assessments using the Electronic Health Record in Older Adults with Advanced CKD

Contact Info

Product

Resources

About