June 2014

Palliat Med. 2014 Mar 24. [Epub ahead of print]

The ‘surprise’ question in advanced cancer patients: A prospective study among general practitioners

Moroni M, Zocchi D, Bolognesi D, Abernethy A, Rondelli R, Savorani G, Salera M, Dall’olio FG, Galli G, Biasco G; on behalf of the SUQ-P group

In a prospective cohort study of 42 general practitioners (GPs) in Italy, the prognostic accuracy of the ‘surprise’ question ‘Would you be surprised if this patient died in the next year?’ was used over a 3 month period for 231 consecutive patients with stage IV solid cancers. After 1 year it was assessed if the patient was alive with the aim of assessing the consistency between GPs’ response to the ‘surprise’ question and survival. The GPs answered no for 126 (55%) patients and ‘Yes’ for 105 (46%). After 1 year, 104 (45%) patients had died; 87 (84%) were in the ‘No’ group. The answer to the ‘surprise’ question correlated with survival at 1 year. The sensitivity of the ‘surprise’ question was 69%; the specificity was 84%. Positive predictive value was 84%; negative predictive value was 69%. There was however a trend to underestimate patients’ survival with 39 (31%) of patients in the ‘No’ group surviving beyond 1 year. The authors suggest that the ‘surprise’ question should be used by general practitioners as a screening Instrument to help identify patients with advanced cancer who might benefit from palliative care.

Prepared by Jason Boland