Jill Rice1, Linda Hunter2, Amy T Hsu3,4,5, Melissa Donskov1, Tracy Luciani1, Darene Toal-Sullivan6, Vivian Welch3,4,6, Peter Tanuseputro3,6,7. 1. 1 Bruyère Continuing Care, Ottawa, Ontario, Canada. 2. 2 Perley and Rideau Veterans' Health Centre, Ottawa, Ontario, Canada. 3. 3 Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada. 4. 4 University of Ottawa, School of Epidemiology and Public Health, Ottawa, Ontario, Canada. 5. 5 Institute for Clinical Evaluative Sciences (ICES), ICES uOttawa, Ottawa, Ontario, Canada. 6. 6 Bruyère Research Institute, Ottawa, Ontario, Canada. 7. 7 Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Abstract
BACKGROUND: The "Surprise Question" (SQ) is often used to identify patients who may benefit from a palliative care approach. The time frame of the typical question (a 12-month prognosis) may be unsuitable for identifying residents in nursing homes since it may not be able to differentiate between those who have a more imminent risk of death within a cohort of patients with high care needs. OBJECTIVE: To examine the accuracy and acceptability of 3 versions of the SQ with shortened prognostication time frames (3 months, 6 months, and "the next season") in the nursing home setting. DESIGN: A prospective mixed-methods study. SETTING/PARTICIPANTS: Forty-seven health-care professionals completed the SQ for 313 residents from a nursing home in Ontario, Canada. A chart audit was performed to evaluate the accuracy of their responses. Focus groups and interviews were conducted to examine the participants' perspectives on the utility of the SQ. RESULTS: Of the 301 residents who were included in the analysis, 74 (24.6%) deaths were observed during our follow-up period. The probability of making an accurate prediction was highest when the seasonal SQ was used (66.7%), followed by the 6-month (58.9%) and 3-month (57.1%) versions. Despite its high accuracy, qualitative results suggest the staff felt the seasonal SQ was ambiguous and expressed discomfort with its use. CONCLUSION: The SQ with shortened prognostication periods may be useful in nursing homes and provides a mechanism to facilitate discussions on palliative care. However, a better understanding of palliative care and increasing staff's comfort with prognostication is essential to a palliative care approach.
BACKGROUND: The "Surprise Question" (SQ) is often used to identify patients who may benefit from a palliative care approach. The time frame of the typical question (a 12-month prognosis) may be unsuitable for identifying residents in nursing homes since it may not be able to differentiate between those who have a more imminent risk of death within a cohort of patients with high care needs. OBJECTIVE: To examine the accuracy and acceptability of 3 versions of the SQ with shortened prognostication time frames (3 months, 6 months, and "the next season") in the nursing home setting. DESIGN: A prospective mixed-methods study. SETTING/PARTICIPANTS: Forty-seven health-care professionals completed the SQ for 313 residents from a nursing home in Ontario, Canada. A chart audit was performed to evaluate the accuracy of their responses. Focus groups and interviews were conducted to examine the participants' perspectives on the utility of the SQ. RESULTS: Of the 301 residents who were included in the analysis, 74 (24.6%) deaths were observed during our follow-up period. The probability of making an accurate prediction was highest when the seasonal SQ was used (66.7%), followed by the 6-month (58.9%) and 3-month (57.1%) versions. Despite its high accuracy, qualitative results suggest the staff felt the seasonal SQ was ambiguous and expressed discomfort with its use. CONCLUSION: The SQ with shortened prognostication periods may be useful in nursing homes and provides a mechanism to facilitate discussions on palliative care. However, a better understanding of palliative care and increasing staff's comfort with prognostication is essential to a palliative care approach.
Entities:
Keywords:
advance care planning; clinical decision-making; end-of-life care; long-term care; nursing homes; palliative care
Authors: Markus Ebke; Andreas Koch; Kim Dillen; Ingrid Becker; Raymond Voltz; Heidrun Golla Journal: Front Neurol Date: 2018-09-24 Impact factor: 4.003
Authors: Ana A Esteban-Burgos; María José Lozano-Terrón; Daniel Puente-Fernandez; César Hueso-Montoro; Rafael Montoya-Juárez; María P García-Caro Journal: Int J Environ Res Public Health Date: 2021-03-19 Impact factor: 3.390