Prevalence and characteristics of patients with advanced chronic conditions in need of palliative care in the general population: A cross-sectional study

Gómez-Batiste, Xavier; Martínez-Muñoz, Marisa; Blay, Carles; Amblàs-Novellas, Jordi; Vila, Laura; Costa, Xavier; Espaulella, Joan; Espinosa, José; Constante, Carles; Mitchell, Geoffrey

doi:10.1177/0269216313518266

Cited by 201 publications

(177 citation statements)

References 55 publications

Supporting

Mentioning

141

Contrasting

Unclassified

Order By: Relevance

“…However, their study was conducted in an advanced chronic disease population in primary and hospital care, rather than a general hospital setting. They also found a level of agreement on SQ+ between medical and nursing staff similar to our study (kappa 0.48) 23. Similarly, investigators comparing SQ alone or SQ plus several other clinical predictors in 207 older emergency department patients found sensitivity 77%, specificity 56%, PPV 32% and NPV 90% with both approaches, with a similar 12-month mortality to our study (21%); physicians identified 49% of patients at risk using SQ+ alone.…”

Section: Discussionsupporting

confidence: 87%

Risk of 12-month mortality among hospital inpatients using the surprise question and SPICT criteria: a prospective study

Mudge

Douglas

Sansome

et al. 2018

BMJ Support Palliat Care

View full text Add to dashboard Cite

show abstract

Section: Discussionsupporting

confidence: 87%

Risk of 12-month mortality among hospital inpatients using the surprise question and SPICT criteria: a prospective study

Mudge

Douglas

Sansome

et al. 2018

BMJ Support Palliat Care

View full text Add to dashboard Cite

show abstract

“…First, clinicians may only have moderate agreement when answering the SQ, with more experienced clinicians generally more accurate than those with less experience. 30,44 Second, although many of the singlecentre studies showed a high response rate, some clinicians may be reluctant to adopt the SQ into routine practice; 21,25,45 1 study reported that discomfort among staff led to the SQ being dropped as a trigger for a care bundle for patients in hospital. 46 This discomfort is an important problem for a test that depends on clinician participation.…”

Section: Discussionmentioning

confidence: 99%

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

Downar

Goldman

Pinto

et al. 2017

CMAJ

312

263

View full text Add to dashboard Cite

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.

show abstract

“…1,25 This article aims to build upon prior work by conceptually defining serious illness and describing the steps needed to operationalize this definition within a healthcare population. [26][27][28][29][30] We align these methods with current alternative payment model (APM) proposals 31,32 and highlight critical challenges and tensions in specifying the approach. To illustrate these issues, we also describe simulated examples of population identification methods using a nationally representative cohort of Medicare beneficiaries.…”

Section: Introductionmentioning

confidence: 99%

Identifying the Population with Serious Illness: The “Denominator” Challenge

KelleyAmy

Bollens-LundEvan

2018

Journal of Palliative Medicine

159

118

View full text Add to dashboard Cite

Background: To ensure seriously ill people and their families receive high-quality primary and specialty palliative care services, rigorous methods are needed to prospectively identify this population. Objective: To define and operationalize a definition of serious illness for the purpose of identifying patients and caregivers who need primary or specialty palliative care services. Design/Setting: Two stages of work included (1) building expert consensus around a conceptual definition of serious illness and (2) using the National Health and Aging Trends Study linked to Medicare claims data to test a range of operational definitions composed of diagnoses, utilization, and markers of care needs. Measurements: One-year outcomes included mean total Medicare costs, mortality, and percent hospitalized, as well as those reporting ‡2 measures of need and functional impairment. Sensitivity, specificity, and c-statistics (unadjusted and adjusted for age, sex, race, and Medicaid status) were calculated for each definition across the outcomes. Results: Conceptually, ''Serious illness'' is a health condition that carries a high risk of mortality AND either negatively impacts a person's daily function or quality of life, OR excessively strains their caregivers. The range of operational definitions simulated all had low sensitivity and high specificity across all outcomes. None of the definitions reached an unadjusted c-statistic >0.6 (or adjusted >0.7) for identifying a population with ‡2 indicators of care needs. Conclusions: Standard administrative data are inadequate to identify this population. Defining the seriously ill denominator with high specificity, as described here, will focus efforts toward the highest-need segment of the population, who may indeed benefit most.

show abstract

Prevalence and characteristics of patients with advanced chronic conditions in need of palliative care in the general population: A cross-sectional study

Abstract: Direct measurement of prevalence of palliative care needs on a population basis is feasible. Early identification and prevalence determination of these patients is likely to be the cornerstone of palliative care public health policies.

Cited by 201 publications

References 55 publications

Risk of 12-month mortality among hospital inpatients using the surprise question and SPICT criteria: a prospective study

Risk of 12-month mortality among hospital inpatients using the surprise question and SPICT criteria: a prospective study

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

Identifying the Population with Serious Illness: The “Denominator” Challenge

Contact Info

Product

Resources

About