Early identification of patients in need of palliative care in slovenian general practice

Klok, Lisette; Engels, Yvonne; Veldhoven, Carel; Pavlič, Danica Rotar

doi:10.2478/sjph-2018-0008

Cited by 8 publications

(6 citation statements)

References 29 publications

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“…Case vignette studies showed that general practitioners are willing to use the Double Surprise Question. 17 , 18 In an explorative study, the prognostic accuracy of the Double Surprise Question for patients aged ⩾75 years in general practice was examined. It was shown that the Double Surprise Question is able to discriminate between patients with different life expectancies and palliative care needs.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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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.

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Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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“…Accordingly, the NP demonstrated higher accuracy for predicting whether patients would still be alive after 12 months compared to PCP. Our results suggest the use of “12-SQ2”: “Would I be surprised if this patient is still alive after twelve months?” ( 45 ) for physicians with a background in neurology or a combination of the original 12-SQ and the 12-SQ2, which has been piloted in a sample of general practitioners ( 45 , 46 ).…”

Section: Discussionmentioning

confidence: 99%

The “Surprise Question” in Neurorehabilitation—Prognosis Estimation by Neurologist and Palliative Care Physician; a Longitudinal, Prospective, Observational Study

et al. 2018

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Background: The 12-months “surprise” question (12-SQ) for estimating prognosis and the need for integrating palliative care (PC) services has not yet been investigated for neurological patients.Objective: Test the value of the 12-SQ on a sample of neurorehabilitation patients.Methods: All patients newly registered in the Department of Neurorehabilitation, Dr. Becker Rhein-Sieg-Clinic (8/2016-03/2017) were asked to participate. The treating neurorehabilitation physicians (NP) and an external consulting PC physician (PCP) independently estimated patients' prognosis using the 12-SQ; while symptom burden was independently assessed using the standardized palliative outcome measurement HOPE-SP-CL, a set of additional neurological issues, and ECOG. Follow-up with consenting patients 12 months later was via telephone. Descriptive and inferential statistics were utilized in data analysis.Results: Of 634 patients, 279 (44%) patients (male: 57.7%, female: 42.3%; mean age: 63 ± 14) (or, alternatively, their legal representative) consented and were assessed at baseline. Per patient NP and PCP both answered the 12-SQ with “Yes” (164), with “No” (42), or had different opinions (73). The “No” group displayed the highest symptom burden on all three measures for both disciplines. Overall, PCP scored higher (i.e., worse) than NP on all measures used. Follow-up was possible for 236 (drop-out: 15.4%) patients (deceased: 34 (14.4%), alive: 202 (85.6%)). Baseline scores on all measures were higher for deceased patients compared to those still living. Prognostic characteristics were: sensitivity: NP 50%, PCP 67.6%; specificity: NP 86.1%, PCP 70.3%, p < 0.001; positive predictive value: NP 37.8%, PCP 27.7%; negative predictive value: NP 91.1%, PCP 92.8%; area under the curve: NP 0.68, PCP 0.69; success rate: NP 80.9%, PCP 69.9%, p = 0.002. Regression analysis indicated that age, dysphagia and overburdening of family (NP answering the 12-SQ), dysphagia and rehabilitation phase (PCP answering the 12-SQ) were associated with increased likelihood of dying within 12 months. Without the 12-SQ as relevant predictor, age, dysphagia and ECOG were significant predictors (NP and PCP).Conclusion: Combining the 12-SQ with a measurement assessing PC and neurological issues could potentially improve the 12-SQ's predictive performance of 12-month survival and help to identify when to initiate the PC approach. Clinical experiences influence assessment and prognosis estimation.

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“…We identified many facilitators to improve the organization of palliative care. Similar facilitators regarding the organization of palliative care and useful tools exist in different countries (van Riet Paap, et al, 2014;Mistry, et al, 2015;Klok, et al, 2018, WHO, 2014):…”

Section: Facilitatorsmentioning

confidence: 98%

Palliative care in primary care: European Forum for Primary Care position paper

Pavlič

Aarendonk²,

Wens

et al. 2019

Prim Health Care Res Dev

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Aim:The aim of this position paper is to assist primary health care (PHC) providers, policymakers, and researchers by discussing the current context in which palliative health care functions within PHC in Europe. The position paper gives examples for improvements to palliative care models from studies and international discussions at European Forum for Primary Care (EFPC) workshops and conferences.Background:Palliative care is a holistic approach that improves the quality of life of patients and their families facing problems associated with terminal illness, through the prevention and relief of suffering by means of early identification and diligent assessment and treatment of pain and other problems, whether physical, psychosocial, or spiritual. Unfortunately, some Europeans, unless they have cancer, still do not have access to generalist or specialist palliative care.Methods:A draft of this position paper was distributed electronically through the EFPC network in 2015, 2016, and 2017. Active collaboration with the representatives of the International Primary Palliative Care Network was established from the very beginning and more recently with the EAPC Primary Care Reference Group. Barriers, opportunities, and examples of good and bad practices were discussed at workshops focusing on palliative care at the international conferences of Southeastern European countries in Ljubljana (2015) and Budva (2017), at regular conferences in Amsterdam (2015) and Riga (2016), at the WONCA Europe conferences in Istanbul (2015), Copenhagen (2016), and Prague (2017), and at the EAPC conference in Madrid (2017).Findings:There is great diversity in the extent and type of palliative care provided in primary care by European countries. Primary care teams (PCTs) are well placed to encourage timely palliative care. We collected examples from different countries. We found numerous barriers influencing PCTs in preparing care plans with patients. We identified many facilitators to improve the organization of palliative care.

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Early identification of patients in need of palliative care in slovenian general practice

Cited by 8 publications

References 29 publications

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

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

The “Surprise Question” in Neurorehabilitation—Prognosis Estimation by Neurologist and Palliative Care Physician; a Longitudinal, Prospective, Observational Study

Palliative care in primary care: European Forum for Primary Care position paper

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