The ‘surprise’ question in advanced cancer patients: A prospective study among general practitioners

Moroni, Matteo; Bolognesi, Deborah; Abernethy, Amy Pickar; Rondelli, Roberto; Dall’Olio, Filippo Gustavo; Galli, Giulia; Biasco, Guido; Balduzzi, Antonio; Bandi, Giulio; Baraldini, Laura; Bauleo, Salvatore; Bertini, Luigi; Borghi, Paolo; Calzoni, Paolo; Camanzi, Maurizio; Cammarata, Antonino; Casarini, P; Cau, Roberto; Deni, Cecilia; Ehrlich, Shirley; Ermini, Giuliano; Franco, Livio; Furlò, Giancarlo; Grandi, Marina; Lalli, Antonio Luigi; Maccaferri, Marco; Marzo, Carla; Masi, Angelo; Matrà, Annunzio; Gaito, Piero Mazzetti; Montanari, Federico; Oggianu, Massimo; Ognibene, Gianluca; Palasciano, Maria; Palestini, Saida; Perrone, Fernando; Quadrelli, Stefano; Rappacciolo, Antonino; Rubini, Stefano; Salera, M.; Santi, Sandra; Savorani, Giandomenico; Serio, Alberto; Severino, Anna Maria; Siena, Matteo; Speziali, Pietro; Spinnato, Luigi; Tosetti, Cesare; Velonà, Pietro; Verri, Andrea; Zocchi, Donato

doi:10.1177/0269216314526273

Cited by 148 publications

(148 citation statements)

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“…14,19 In 3 studies, the SQ was used only to predict 7-and/or 30-day mortality. 29,37,38 Sixteen remaining studies of SQ to predict death met inclusion criteria 1,[20][21][22][23][24][25][26][27][28][30][31][32][33][34][35] (Table 1) and were included in the meta-analysis. One study provided data for a derivation cohort in the manuscript.…”

Section: Resultsmentioning

confidence: 99%

“…34 The SQ was answered by physicians in 13 studies (including oncologists, 26,33,35 nephrologists, 20,22,[30][31][32] respirologists, 23 intensivists, 24 and general practitioners 21,25,34 ), specialist nurses in 1 study, 1 either a physician or a nurse in 1 study 28 and a multidisciplinary team of 2 physicians and a nurse in another study. 27 In each case, the assessors were familiar with the patient.…”

Section: Resultsmentioning

confidence: 99%

“…Of note, 1 study reported that the 12% of eligible patients receiving hemodialysis without a recorded SQ response (because the physician did not answer the question) had higher mortality than those with a response. 20 Among 2 studies reporting provider participation, 1 reported that 8 of 50 (16%) general practitioners declined to participate, 25 and another found that 5 of 16 (31%) general practitioner clinics declined. 21 No study reported incomplete availability of status of death for patients with an SQ response.…”

Section: Resultsmentioning

confidence: 99%

“…1,20,21,[23][24][25][26]31,33,35 One study asked the SQ to a multidisciplinary team, which arrived at an answer by consensus. 27 In 1 study of patients receiving hemodialysis, every physician and nurse working with that patient was asked the SQ independently; to be consistent, we considered that the patient was SQ+ if either of the 2 physicians attending in their unit responded "no" to the SQ.…”

Section: Identificationmentioning

confidence: 99%

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The “surprise question” for predicting death in seriously ill patients: a systematic review and meta-analysis

Downar

Goldman

Pinto

et al. 2017

CMAJ

321

263

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T he surprise question (SQ) was developed more than a decade ago and has been suggested as a simple test to identify patients who might benefit from hospice and palliative care (HPC).1 It involves a clinician reflecting on the question, "Would I be surprised if this patient died in the next 12 months?". It was thought that the SQ would correct for a physician's tendency to overestimate prognosis 2 by asking the physician to consider whether death in the coming year is possible rather than probable. The surprise question has been widely promoted 3,4 and adopted into frameworks for assessing hospice and palliative care needs. 5,6 In the past few years, several studies have reported on the accuracy of the SQ for a different purpose: as a prognostic test of intermediate-term death in different patient populations. These studies sought to determine whether an answer of "no" (hereafter SQ+) predicts intermediate-term death. We conducted a systematic review of the literature to determine the performance characteristics of the SQ in predicting death and the methodologic characteristics of these studies. Methods Search strategyWe searched MEDLINE (from 1946 to week 2 of October 2016), MEDLINE in process (to Oct. 19, 2016), Embase (1947 to Oct. 19, 2016 The surprise question -"Would I be surprised if this patient died in the next 12 months?" -has been used to identify patients at high risk of death who might benefit from palliative care services. Our objective was to systematically review the performance characteristics of the surprise question in predicting death.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Identificationmentioning

confidence: 99%

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The “surprise question” for predicting death in seriously ill patients: a systematic review and meta-analysis

Downar

Goldman

Pinto

et al. 2017

CMAJ

321

263

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“…The so-called "surprise question" ("Would I be surprised if this patient died in the next 12 months?" [59,60]) has proved helpful in estimating the 12-month survival probability of patients with oncological or nephrological diseases [59,60]. If this might be true also for neurological diseases still needs to be clarified.…”

Section: Considerations To Improve the Care Of Neurological Patients mentioning

confidence: 99%

Untitled

2017

Neurology International Open

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AbSTR AC TAlthough patients with incurable neurological diseases suffer from a variety of distressing symptoms and may die from their neurological condition and associated complications, palliative and hospice care for these patients to date remains rare. Initial estimates indicate that on average 10 % of all patients suffering from a neurological disease need palliative and hospice care. However, within German neurology departments, only few physicians (on average 1.3/department) and nurses (on average 2.2./department) are specialized in palliative and hospice care and only about 3 % of patients cared for in palliative or hospice care structures suffer from neurological diseases (in contrast to the approximately 80 % of patients suffering from oncological diseases). This rather low number is due to the gradual increase in the awareness of palliative and hospice care needs for neurological patients and a currently predominant supply of oncological patients in palliative and hospice care structures that are primarily aimed at these patients. Correspondingly, the special aspects of neurological patients are currently not adequately addressed in the palliative training curricula of healthcare professionals. Rather, patients with advanced neurological conditions are medically cared for by general practitioners and by the existing inpatient and outpatient neurology structures, which may also offer sub-specialty services. Consequently, adequate care for severely affected neurological patients becomes difficult as soon as these patients are hardly able to visit these structures because home-based specialist treatment is currently rendered and financed only to a limited degree. Novel yet to date rare approaches, mostly of international origin, suggest that these patients may benefit from specialized home-based services, combining neurological and palliative care expertise. At present, data that characterizes the situation of neuro-palliative care in Germany remains scarce. In addition to the already known supply gaps (e. g., low rate of neurologists trained in palliative medicine as well as of nurses working in neurology E117

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Safety and Benefit of Discontinuing Statin Therapy in the Setting of Advanced, Life-Limiting Illness

et al. 2015

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The ‘surprise’ question in advanced cancer patients: A prospective study among general practitioners

Abstract: When general practitioners used the 'surprise' question for their patients with advanced cancer, the accuracy of survival prognosis was very high. This has clinical potential as a method to identify patients who might benefit from palliative care.

Cited by 148 publications

References 29 publications

The “surprise question” for predicting death in seriously ill patients: a systematic review and meta-analysis

The “surprise question” for predicting death in seriously ill patients: a systematic review and meta-analysis

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Safety and Benefit of Discontinuing Statin Therapy in the Setting of Advanced, Life-Limiting Illness

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