BackgroundC linicians have been encouraged to utilize the surprise question (SQ)-''Would I be surprised if this patient died within 12 months?''-to identify patients at high one-year mortality risk. When clinicians answer ''No-I would NOT be surprised if this patient died within 12 months,'' the SQ may help clinicians identify patients with unmet palliative care needs who could benefit from advance care planning discussions and/or a palliative care referral. 1 This Fast Fact reviews the clinical utility of the SQ.
Rationale of the SQFast Facts and Concepts are edited by Sean Marks, MD (Medical College of Wisconsin), and Associate Editor Drew A. Rosielle, MD (University of Minnesota Medical School), with the generous support of a volunteer peer-review editorial board, and are made available online by the Palliative Care Network of Wisconsin (PCNOW); the authors of each individual Fast Fact are solely responsible for that Fast Fact's content. The full set of Fast Facts is available at PCNOW with contact information, and how to reference Fast Facts.
The prognostic accuracy of palliative care physicians in this study was similar to physician accuracy in other studies. Trends toward overestimation were also similar to those seen in previous research. Use of a template in the electronic medical record (EMR) increases documentation of estimated prognosis.
E-mailed FFAC are an educational intervention that increases intern medical knowledge and self-reported preparedness in symptom management skills but not preparedness in communication skills or satisfaction with palliative care education.
PS is the preferred term among HPC clinicians for the proportionate use of pharmacotherapies to intentionally lower awareness for refractory symptoms in dying patients. PS is a bioethically appropriate treatment for refractory symptoms in dying patients. However, there is a lack of clear agreement about what is included in PS and how the practice of PS should be best delivered in different clinical scenarios. Future efforts to investigate PS should focus on describing the clinical scenarios in which PS is utilized and on the level of intended sedation necessary, in an effort to better unify the practice of PS.
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