Prognostic Significance of the “Surprise” Question in Cancer Patients

Moss, Alvin H.; Lunney, June R.; Culp, Stacey; Auber, Miklos; Kurian, Sobha; Rogers, John; Dower, Joshua; Abraham, Jame

doi:10.1089/jpm.2010.0018

Cited by 303 publications

(189 citation statements)

References 11 publications

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“…The individual physician’s performances varied substantially, particularly for 12-month mortality prediction. Our PM also performed better than the 6-month and 12-month SQ performance previously reported in the Cohen et al [4] and Moss et al [10] studies in both the validation and SQ cohorts, respectively [4, 10]. …”

Section: Resultssupporting

confidence: 54%

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Performance of the Surprise Question Compared to Prediction Models in Hemodialysis Patients: A Prospective Study

Malhotra¹,

Wang²,

Chen³

et al. 2017

Am J Nephrol

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Background: The surprise question (SQ) (“Would you be surprised if this patient were still alive in 6 or 12 months?”) is used as a mortality prognostication tool in hemodialysis (HD) patients. We compared the performance of the SQ with that of prediction models (PMs) for 6- and 12-month mortality prediction. Methods: Demographic, clinical, laboratory, and dialysis treatment indicators were used to model 6- and 12-month mortality probability in a HD patients training cohort (n = 6,633) using generalized linear models (GLMs). A total of 10 nephrologists from 5 HD clinics responded to the SQ in 215 patients followed prospectively for 12 months. The performance of PM was evaluated in the validation (n = 6,634) and SQ cohorts (n = 215) using the areas under receiver operating characteristics curves. We compared sensitivities and specificities of PM and SQ. Results: The PM and SQ cohorts comprised 13,267 (mean age 61 years, 55% men, 54% whites) and 215 (mean age 62 years, 59% men, 50% whites) patients, respectively. During the 12-month follow-up, 1,313 patients died in the prediction model cohort and 22 in the SQ cohort. For 6-month mortality prediction, the GLM had areas under the curve of 0.77 in the validation cohort and 0.77 in the SQ cohort. As for 12-month mortality, areas under the curve were 0.77 and 0.80 in the validation and SQ cohorts, respectively. The 6- and 12-month PMs had sensitivities of 0.62 (95% CI 0.35–0.88) and 0.75 (95% CI 0.56–0.94), respectively. The 6- and 12-month SQ sensitivities were 0.23 (95% CI 0.002–0.46) and 0.35 (95% CI 0.14–0.56), respectively. Conclusion: PMs exhibit superior sensitivity compared to the SQ for mortality prognostication in HD patients.

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Section: Resultssupporting

confidence: 54%

“…Left and right panels show 6-month and 12-month prediction results, respectively. For comparison, Moss refers to study by Moss et al [10], and Cohen refers to study by Cohen et al [4]. …”

Section: Resultsmentioning

confidence: 99%

Performance of the Surprise Question Compared to Prediction Models in Hemodialysis Patients: A Prospective Study

Malhotra¹,

Wang²,

Chen³

et al. 2017

Am J Nephrol

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“…The question "Would you be surprised if this patient died in the next year?" provided a high index of prediction in patients where the question was answered in the negative [24]. Similar exercises have been conducted with general practitioners and medical specialities [25].…”

Section: Research Initiativesmentioning

confidence: 99%

End-of-life care in the intensive care unit: Report from the Task Force of World Federation of Societies of Intensive and Critical Care Medicine

Myburgh

Abillama

Chiumello

et al. 2016

Journal of Critical Care

102

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“…This 'surprise' question is commonly used to identify individuals nearing the end of life, 74,75 in particular where prognosis is complex, as is the case with heart or renal failure, for example. 76 Along with the criteria listed above, participants had to be aware of their heart failure, stroke or lung cancer diagnosis.…”

Section: Recruitment and Data Collection From Patientsmentioning

confidence: 99%

Transitions at the end of life for older adults – patient, carer and professional perspectives: a mixed-methods study

Hanratty

Lowson

Grande

et al. 2014

Health Services and Delivery Research

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BackgroundThe end of life may be a time of high service utilisation for older adults. Transitions between care settings occur frequently, but may produce little improvement in symptom control or quality of life for patients. Ensuring that patients experience co-ordinated care, and moves occur because of individual needs rather than system imperatives, is crucial to patients’ well-being and to containing health-care costs.ObjectiveThe aim of this study was to understand the experiences, influences and consequences of transitions between settings for older adults at the end of life. Three conditions were the focus of study, chosen to represent differing disease trajectories.SettingEngland.ParticipantsThirty patients aged over 75 years, in their last year of life, diagnosed with heart failure, lung cancer and stroke; 118 caregivers of decedents aged 66–98 years, who had died with heart failure, lung cancer, stroke, chronic obstructive pulmonary disease or selected other cancers; and 43 providers and commissioners of services in primary care, hospital, hospice, social care and ambulance services.Design and methodsThis was a mixed-methods study, composed of four parts: (1) in-depth interviews with older adults; (2) qualitative interviews and structured questionnaire with bereaved carers of older adult decedents; (3) telephone interviews with care commissioners and providers using case scenarios derived from the interviews with carers; and (4) analysis of linked Hospital Episode Statistics (HES) and mortality data relating to hospital admissions for heart failure and lung cancer in England 2001–10.ResultsTransitions between care settings in the last year of life were a common component of end-of-life care across all the data sets that made up this study, and many moves were made shortly before death. Patients’ and carers’ experiences of transitions were of a disjointed system in which organisational processes were prioritised over individual needs. In many cases, the family carer was the co-ordinator and provider of care at home, excluded from participation in institutional care but lacking the information and support to extend their role with confidence. The general practitioner (GP) was a valued, central figure in end-of-life care across settings, though other disciplines were critical of GPs’ expertise and adherence to guidelines. Out-of-hours services and care homes were identified by many as contributors to unnecessary transitions. Good relationships and communication between professionals in different settings and sectors was recognised by families as one of the most important influences on transitions but this was rarely acknowledged by staff.ConclusionsDevelopment of a shared understanding of professional and carer roles in end-of-life transitions may be one of the most effective ways of improving patients’ experiences. Patients and carers manage many aspects of end-of-life care for themselves. Identifying ways to extend their skills and strengthen their voices, particularly in hospital settings, would be welcomed and may reduce unnecessary end-of-life transitions. Why the experiences of carers appear to have changed little, despite the implementation of a range of relevant policies, is an important question that has not been answered. Recommendations for future research include the relationship between policy interventions and the experiences of end-of-life carers; identification of ways to harmonise understanding of the carers’ role and strengthen their voice, particularly in hospital settings; identification of ways to reduce the influence of interprofessional tensions in end-of-life care; and development of interventions to enhance patients’ experiences across transitions.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Prognostic Significance of the “Surprise” Question in Cancer Patients

Abstract: The surprise question is a simple, feasible, and effective tool to identify patients with cancer who have a greatly increased risk of 1-year mortality.

Cited by 303 publications

References 11 publications

Performance of the Surprise Question Compared to Prediction Models in Hemodialysis Patients: A Prospective Study

Performance of the Surprise Question Compared to Prediction Models in Hemodialysis Patients: A Prospective Study

End-of-life care in the intensive care unit: Report from the Task Force of World Federation of Societies of Intensive and Critical Care Medicine

Transitions at the end of life for older adults – patient, carer and professional perspectives: a mixed-methods study

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