BACKGROUND: Physicians consistently overestimate survival for patients with cancer. The "surprise" question--"Would I be surprised if this patient died in the next year?"--improves end-of-life care by identifying patients with a poor prognosis. It has not been previously studied in patients with cancer. OBJECTIVE: To determine the efficacy of the surprise question in patients with cancer. DESIGN: Prospective cohort study. SETTING: Academic cancer center. PATIENTS: 853 consecutive patients with breast, lung, or colon cancer. MEASUREMENTS: Surprise question classification and patient status at 12 months, alive or dead, by surprise question response. RESULTS: Oncologists classified 826 of 853 prospective patients with cancer (97%) with 131 (16%) classified into the "No" group and 695 (84%) into the "Yes" group. In multivariate analysis, a "No" response identified patients with cancer who had a seven times greater hazard of death in the next year compared to patients in the "Yes" group (HR 7.787, p < 0.001). LIMITATIONS: Single center study. CONCLUSION: 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.
BACKGROUND: Physicians consistently overestimate survival for patients with cancer. The "surprise" question--"Would I be surprised if this patient died in the next year?"--improves end-of-life care by identifying patients with a poor prognosis. It has not been previously studied in patients with cancer. OBJECTIVE: To determine the efficacy of the surprise question in patients with cancer. DESIGN: Prospective cohort study. SETTING: Academic cancer center. PATIENTS: 853 consecutive patients with breast, lung, or colon cancer. MEASUREMENTS: Surprise question classification and patient status at 12 months, alive or dead, by surprise question response. RESULTS: Oncologists classified 826 of 853 prospective patients with cancer (97%) with 131 (16%) classified into the "No" group and 695 (84%) into the "Yes" group. In multivariate analysis, a "No" response identified patients with cancer who had a seven times greater hazard of death in the next year compared to patients in the "Yes" group (HR 7.787, p < 0.001). LIMITATIONS: Single center study. CONCLUSION: 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.
Authors: Rachel A Rodenbach; Sally A Norton; Marsha N Wittink; Supriya Mohile; Holly G Prigerson; Paul R Duberstein; Ronald M Epstein Journal: Patient Educ Couns Date: 2018-12-12
Authors: Judith M Resick; Robert M Arnold; Rebecca L Sudore; David Farrell; Shane Belin; Andrew D Althouse; Betty Ferrell; Bernard J Hammes; Edward Chu; Douglas B White; Kimberly J Rak; Yael Schenker Journal: Contemp Clin Trials Date: 2020-07-31 Impact factor: 2.226