Tomoo Ikari1, Yusuke Hiratsuka1, Takuhiro Yamaguchi2, Isseki Maeda3, Masanori Mori4, Yu Uneno5, Tomohiko Taniyama6, Yosuke Matsuda7, Kiyofumi Oya8, Keita Tagami1, Akira Inoue1. 1. Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan. 2. Division of Biostatistics, Tohoku University School of Medicine, Sendai, Japan. 3. Department of Palliative Care, Senri-Chuo Hospital, Toyonaka, Japan. 4. Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan. 5. Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan. 6. Department of Oncology and Palliative Medicine, Mitsubishi Kyoto Hospital, Kyoto, Japan. 7. Palliative Care Department, St. Luke's International Hospital, Tokyo, Japan. 8. Aso Iizuka Hospital, Transitional and Palliative Care, Iizuka ciyu, Japan.
Abstract
BACKGROUND: The study aimed to clarify the efficacy of the "3-Day Surprise Question (3DSQ)" in predicting the prognosis for advanced cancer patients with impending death. PATIENTS AND METHODS: This study was a part of multicenter prospective observational study which investigated the dying process in advanced cancer patients in Japan. For patients with a Palliative Performance Scale ≤20, the 3DSQ "Would I be surprised if this patient died in the next 3 days?" was answered by their physicians. In addition to the sensitivity and specificity of the 3DSQ, the characteristics of patients who survived longer than expected were examined via multivariate analysis. RESULTS: Among the 1896 patients enrolled, 1411 were evaluated. Among 1179 (83.6%) patients who were classified into the "Not surprised" group, 636 patients died within 3 days. Among 232 (16.4%) patients of "Yes surprised" group, 194 patients lived longer than 3 days. The sensitivity, specificity, positive predictive value, and negative predictive value of the 3DSQ were 94.3% (95% confidence interval [CI]: 92.7% to 95.8%), 26.3% (95% CI: 24.8% to 27.6%), 53.9% (95% CI: 53.0% to 54.7%), and 83.6% (95% CI: 78.7% to 87.7%), respectively. Multivariate analysis showed palpable radial artery, absent respiration with mandibular movement, SpO2 ≥ 90%, opioid administration, and no continuous deep sedation as characteristics of patients who lived longer than expected. CONCLUSIONS: The 3-Day Surprise Question can be a useful screening tool to identify advanced cancer patients with impending death.
BACKGROUND: The study aimed to clarify the efficacy of the "3-Day Surprise Question (3DSQ)" in predicting the prognosis for advanced cancerpatients with impending death. PATIENTS AND METHODS: This study was a part of multicenter prospective observational study which investigated the dying process in advanced cancerpatients in Japan. For patients with a Palliative Performance Scale ≤20, the 3DSQ "Would I be surprised if this patient died in the next 3 days?" was answered by their physicians. In addition to the sensitivity and specificity of the 3DSQ, the characteristics of patients who survived longer than expected were examined via multivariate analysis. RESULTS: Among the 1896 patients enrolled, 1411 were evaluated. Among 1179 (83.6%) patients who were classified into the "Not surprised" group, 636 patients died within 3 days. Among 232 (16.4%) patients of "Yes surprised" group, 194 patients lived longer than 3 days. The sensitivity, specificity, positive predictive value, and negative predictive value of the 3DSQ were 94.3% (95% confidence interval [CI]: 92.7% to 95.8%), 26.3% (95% CI: 24.8% to 27.6%), 53.9% (95% CI: 53.0% to 54.7%), and 83.6% (95% CI: 78.7% to 87.7%), respectively. Multivariate analysis showed palpable radial artery, absent respiration with mandibular movement, SpO2 ≥ 90%, opioid administration, and no continuous deep sedation as characteristics of patients who lived longer than expected. CONCLUSIONS: The 3-Day Surprise Question can be a useful screening tool to identify advanced cancerpatients with impending death.
Authors: Nicola White; Fiona Reid; Victoria Vickerstaff; Priscilla Harries; Patrick Stone Journal: BMJ Support Palliat Care Date: 2020-03-22 Impact factor: 3.568