Utility of the “Surprise” Question in Predicting Survival among Older Patients with Acute Surgical Conditions

Lilley, Elizabeth J.; Gemunden, Sean A.; Kristo, Gentian; Changoor, Navin R.; Scott, John W.; Rickerson, Elizabeth; Shimizu, Naomi; Salim, Ali; Cooper, Zara

doi:10.1089/jpm.2016.0313

Cited by 35 publications

(37 citation statements)

References 24 publications

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“…’) is a method used when considering whether someone may benefit from palliative care. 37 Hostel staff and healthcare professionals indicated that for many homeless people, the answer to this question would be ‘no’. Their health is often poor, and their needs are complex making it hard to identify who might be considered palliative.…”

Section: Resultsmentioning

confidence: 99%

End-of-life care for homeless people: A qualitative analysis exploring the challenges to access and provision of palliative care

et al. 2017

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Background:Being homeless or vulnerably housed is associated with death at a young age, frequently related to medical problems complicated by drug or alcohol dependence. Homeless people experience high symptom burden at the end of life, yet palliative care service use is limited.Aim:To explore the views and experiences of current and formerly homeless people, frontline homelessness staff (from hostels, day centres and outreach teams) and health- and social-care providers, regarding challenges to supporting homeless people with advanced ill health, and to make suggestions for improving care.Design:Thematic analysis of data collected using focus groups and interviews.Participants:Single homeless people (n = 28), formerly homeless people (n = 10), health- and social-care providers (n = 48), hostel staff (n = 30) and outreach staff (n = 10).Results:This research documents growing concern that many homeless people are dying in unsupported, unacceptable situations. It highlights the complexities of identifying who is palliative and lack of appropriate places of care for people who are homeless with high support needs, particularly in combination with substance misuse issues.Conclusion:Due to the lack of alternatives, homeless people with advanced ill health often remain in hostels. Conflict between the recovery-focused nature of many services and the realities of health and illness for often young homeless people result in a lack of person-centred care. Greater multidisciplinary working, extended in-reach into hostels from health and social services and training for all professional groups along with more access to appropriate supported accommodation are required to improve care for homeless people with advanced ill health.

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Section: Resultsmentioning

confidence: 99%

End-of-life care for homeless people: A qualitative analysis exploring the challenges to access and provision of palliative care

et al. 2017

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“…Four studies had insufficient data to be included in the meta-analysis. Three authors responded to requests, but were unable to provide additional data to that presented in the paper [ 37 , 39 ]. One author was not contactable [ 38 ].…”

Section: Studies With Incomplete Datamentioning

confidence: 99%

“…The actual survival figures were not reported [ 36 ]. Lilley et al [ 39 ] reported on the accuracy of 28 clinicians who provided responses for 163 patients. Their results show a ‘No’ SQ response was given in 93 cases (60%).…”

Section: Studies With Incomplete Datamentioning

confidence: 99%

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How accurate is the ‘Surprise Question’ at identifying patients at the end of life? A systematic review and meta-analysis

White

Kupeli

Vickerstaff

et al. 2017

BMC Med

238

197

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BackgroundClinicians are inaccurate at predicting survival. The ‘Surprise Question’ (SQ) is a screening tool that aims to identify people nearing the end of life. Potentially, its routine use could help identify patients who might benefit from palliative care services. The objective was to assess the accuracy of the SQ by time scale, clinician, and speciality.MethodsSearches were completed on Medline, Embase, CINAHL, AMED, Science Citation Index, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Open Grey literature (all from inception to November 2016). Studies were included if they reported the SQ and were written in English. Quality was assessed using the Newcastle–Ottawa Scale.ResultsA total of 26 papers were included in the review, of which 22 reported a complete data set. There were 25,718 predictions of survival made in response to the SQ. The c-statistic of the SQ ranged from 0.512 to 0.822. In the meta-analysis, the pooled accuracy level was 74.8% (95% CI 68.6–80.5). There was a negligible difference in timescale of the SQ. Doctors appeared to be more accurate than nurses at recognising people in the last year of life (c-statistic = 0.735 vs. 0.688), and the SQ seemed more accurate in an oncology setting 76.1% (95% CI 69.7–86.3).ConclusionsThere was a wide degree of accuracy, from poor to reasonable, reported across studies using the SQ. Further work investigating how the SQ could be used alongside other prognostic tools to increase the identification of people who would benefit from palliative care is warranted.Trial registrationPROSPERO CRD42016046564.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-017-0907-4) contains supplementary material, which is available to authorized users.

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“…We recently completed a systematic search and analysis. We searched for "surprise question" in five electronic databases (MEDLINE, Embase, PsycINFO, Cochrane Library and CINAHL) and identified two additional full papers (Lilley and colleagues, and Gómez-Batiste and colleagues) 2,3 with values of 82.2% and 93.7% for sensitivity, and 48.7% and 26.4% for specificity, respectively. Downar and colleagues 1 included six published abstracts; we believe that these should be considered with caution, because results can change following peer (including statistical) review.…”

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confidence: 99%

About the “surprise question”

Costantini

Higginson

Merlo

et al. 2017

CMAJ

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Utility of the “Surprise” Question in Predicting Survival among Older Patients with Acute Surgical Conditions

Abstract: The surprise question is a valuable tool for identifying older patients with higher risk of death, and it may be a useful screening criterion for older emergency general surgery patients who would benefit from palliative care evaluation.

Cited by 35 publications

References 24 publications

End-of-life care for homeless people: A qualitative analysis exploring the challenges to access and provision of palliative care

End-of-life care for homeless people: A qualitative analysis exploring the challenges to access and provision of palliative care

How accurate is the ‘Surprise Question’ at identifying patients at the end of life? A systematic review and meta-analysis

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