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

Abstract

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.

Palliativmedizin: von zeitgerechter Integration bis Umgang mit unerträglichem Leid

“…In einer Metaanalyse von 22 Arbeiten zur SQ zeigte sich ein gepoolter Genauigkeitsgrad von fast 75 % (Pooled Accuracy Level 74,8 %, 95 %-KI 68,6-80,5) [17]. In einem neueren systematischen Review wurden diese Ergebnisse bestätigt: die Autoren resümieren, dass die Antwort "Nein, ich wäre nicht überrascht" ein mehrdimensionales Screening auf Symptome, Probleme und Bedürfnisse rechtfertigt und dass eine Einbindung der spezialisierten Palliativversorgung so angezeigt sein kann [18].…”

Characteristics of timely integration of palliative care into oncology hospital care for patients with incurable cancer: results of a Delphi Study

“…However, there are no o cial (inter)national guidelines for timely integration of PC into oncology hospital care for patients with incurable cancer. Most hospitals focus on different elements of timely integrated care, such as developing standardised integrated pathways [11,12], using an online symptom-monitoring and management tool [13] or researching prognostic instruments such as the surprise question [14], leading to a wide variety in clinical practice. Therefore, the aim of this study was to identify elements of timely integration of PC in oncological hospital care in the Netherlands and to achieve consensus among oncology-and PC specialists on the essential characteristics of these identi ed elements, using the following research questions: 1) How do hospitals with oncology care embed different elements of timely integration of PC in their daily clinical practice?…”

Timely integration of palliative care into cancer care

“…Early identification of patients in needs of palliative care is important, and the routinely use of assessments tools can help. One tool for identify patients with potential palliative care needs is the Surprise Question “Would I be surprised if this patient died in the next 12 months?” Stoppelenburg et al showed that the Surprise Question predicts death in hospitalised patients with cancer reasonably well and can help to initiate palliative care earlier (Stoppelenburg et al, 2022). Another tool is the Clinical Frailty Scale (CFS), although still limited used in oncology, Welford et al showed that in adult oncology inpatients, the CFS is associated with prognosis and care needs on discharge and may help predict prognosis in adult oncology inpatients (Welford et al, 2022).…”