Timely identification of patients in need of palliative care using the Double Surprise Question: A prospective study on outpatients with cancer.

Abstract:

BACKGROUND:The Surprise Question ("Would I be surprised if this patient were to die within the next 12 months?") is widely used to identify palliative patients, though with low predictive value. To improve timely identification of palliative care needs, we propose an additional Surprise Question ("Would I be surprised if this patient is still alive after 12 months?") if the original Surprise Question is answered with "no." The combination of the two questions is called the Double Surprise Question. AIM:To examine the prognostic accuracy of the Double Surprise Question in outpatients with cancer. DESIGN:A prospective study. PARTICIPANTS:Twelve medical oncologists completed the Double Surprise Question for 379 patients. RESULTS:In group 1 (original Surprise Question "yes": surprised if dead) 92.1% (176/191) of the patients were still alive after 1 year, in group 2a (original and additional Surprise Question "no": not surprised if dead and not surprised if alive) 60.0% (63/105), and in group 2b (original Surprise Question "no," additional Surprise Question "yes": surprised if alive) 26.5% (22/83) (p < 0.0001). The positive predictive value increased by using the Double Surprise Question; 74% (61/83) vs 55% (103/188). Anticipatory palliative care provision and Advance Care Planning items were most often documented in group 2b. CONCLUSIONS:The Double Surprise Question is a promising tool to more accurately identify outpatients with cancer at risk of dying within 1 year, and therefore, those in need of palliative care. Studies should reveal whether the implementation of the Double Surprise Question leads to more timely palliative care.

journal_name

Palliat Med

journal_title

Palliative medicine

authors

Ermers DJ,Kuip EJ,Veldhoven C,Schers HJ,Perry M,Bronkhorst EM,Vissers KC,Engels Y

doi

10.1177/0269216320986720

subject

Has Abstract

pub_date

2021-01-11 00:00:00

pages

269216320986720

eissn

0269-2163

issn

1477-030X

pub_type

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