BACKGROUND/AIMS: The 'surprise question' (SQ) may aid timely identification of patients with end-of-life care needs. We assessed its prognostic value and variability among clinicians caring for a cohort of haemodialysis (HD) patients. METHODS: Clinicians (29 nurses and 6 nephrologists) in each of our 3 HD units were asked to pose the SQ concerning all patients dialysing in their unit. There were 344 patients, 116 in Unit 1, 132 in Unit 2 and 96 in Unit 3. RESULTS: An adverse SQ response: 'I would not be surprised if this patient were to die in the next 12 months' was reported by individual clinicians for between 6 and 43% of patients (mean 24 ± 9%). Nephrologists responded adversely for more patients than nurses did. Fifty-two patients died during the 12 months of follow-up. There were wide variations between clinicians in the predictive power of SQ responses. Mean odds ratios were significantly higher for nephrologists than for nurses. SQ responses of 49% of clinicians improved baseline models of 12-month mortality, more so for nephrologists (67%) than for senior nurses (50%) and nurses of lesser seniority (36%). Unit performance differed significantly. Agreements between clinicians on SQ responses improved the positive predictive value, i.e. the more clinicians agreed on an adverse response, the greater its predictive power. CONCLUSION: SQ provides a unique contribution to the prediction of short-term prognosis in HD patients, though predictive power varies with clinical discipline, seniority and clinical setting. Agreements between clinicians on adverse responses may have clinical utility.
BACKGROUND/AIMS: The 'surprise question' (SQ) may aid timely identification of patients with end-of-life care needs. We assessed its prognostic value and variability among clinicians caring for a cohort of haemodialysis (HD) patients. METHODS: Clinicians (29 nurses and 6 nephrologists) in each of our 3 HD units were asked to pose the SQ concerning all patients dialysing in their unit. There were 344 patients, 116 in Unit 1, 132 in Unit 2 and 96 in Unit 3. RESULTS: An adverse SQ response: 'I would not be surprised if this patient were to die in the next 12 months' was reported by individual clinicians for between 6 and 43% of patients (mean 24 ± 9%). Nephrologists responded adversely for more patients than nurses did. Fifty-two patients died during the 12 months of follow-up. There were wide variations between clinicians in the predictive power of SQ responses. Mean odds ratios were significantly higher for nephrologists than for nurses. SQ responses of 49% of clinicians improved baseline models of 12-month mortality, more so for nephrologists (67%) than for senior nurses (50%) and nurses of lesser seniority (36%). Unit performance differed significantly. Agreements between clinicians on SQ responses improved the positive predictive value, i.e. the more clinicians agreed on an adverse response, the greater its predictive power. CONCLUSION: SQ provides a unique contribution to the prediction of short-term prognosis in HDpatients, though predictive power varies with clinical discipline, seniority and clinical setting. Agreements between clinicians on adverse responses may have clinical utility.
Authors: Cécile Couchoud; Brenda Hemmelgarn; Peter Kotanko; Michael J Germain; Olivier Moranne; Sara N Davison Journal: Clin J Am Soc Nephrol Date: 2016-08-10 Impact factor: 8.237
Authors: Emma Wilkinson; Gurch Randhawa; Edwina Brown; Maria Da Silva Gane; John Stoves; Graham Warwick; Tahira Akhtar; Regina Magee; Sue Sharman; Ken Farrington Journal: BMC Palliat Care Date: 2016-07-11 Impact factor: 3.234
Authors: Markus Ebke; Andreas Koch; Kim Dillen; Ingrid Becker; Raymond Voltz; Heidrun Golla Journal: Front Neurol Date: 2018-09-24 Impact factor: 4.003