← Back to Search
Using The Surprise Question To Identify Those With Unmet Palliative Care Needs In Emergency And Inpatient Settings: What Do Clinicians Think?
S. Haydar, Lisa Almeder, Lauren Michalakes, P. Han, T. Strout
Published 2017 · Medicine
Save to my Library
Download PDFAnalyze on Scholarcy
BACKGROUND The surprise question (SQ), "Would you be surprised if this patient died within the next year?" is effective in identifying end-stage renal disease and cancer patients at high risk of death and therefore potentially unmet palliative care needs. Following implementation of the SQ in our acute care setting, we sought to explore hospital-based providers' perceptions of the tool. OBJECTIVES To evaluate (1) providers' perceptions regarding the feasibility of SQ use in emergency and inpatient settings, (2) clinician perceptions regarding the utility of the SQ, and (3) barriers to SQ use. DESIGN A cross-sectional survey of medical providers following addition of the SQ to the electronic record for all patients admitted to a tertiary care hospital. RESULTS A total of 111/203 (55%) providers participated: 48/57 (84%) emergency physicians (EPs) and 63/146 (43%) inpatient providers (IPs). Most reported no difficulty using the SQ. Modest numbers in both groups reported that the SQ influenced care delivery (EPs 37%, IPs 42%) as well as goals of care (EPs 45%, IPs 52%). At least some advance care planning discussions were prompted by the SQ (EPs 45%, IPs 58%). Team discussions were influenced by SQ use for more than half of each group. Most respondents (55%) expressed some concern that their SQ responses could be inaccurate. CONCLUSIONS In this setting, clinicians indicated that use of the SQ is feasible, acceptable, and useful in facilitating advance care planning discussions among teams, patients, and families. Many reported that SQ use influenced goals of care, but concern regarding accuracy was a barrier. Additional research examining SQ accuracy and predictive ability is warranted.
This paper references
Trajectories of end-of-life care in the emergency department.
Cara J Bailey (2011)
A review of the trials which examine early integration of outpatient and home palliative care for patients with serious illnesses.
M. Davis (2015)
221 Utility of the Modified “Surprise Question” for Predicting Inpatient Mortality in Emergency Department Patients
T. Strout (2015)
Improving Palliative Care
D. Meier (1997)
Extent of palliative care need in the acute hospital setting: A survey of two acute hospitals in the UK
C. Gardiner (2013)
Predicting six-month mortality for patients who are on maintenance hemodialysis.
L. Cohen (2010)
Palliative care in emergency medicine: past, present, and future.
T. Quest (2012)
Early goal-directed palliative therapy in the emergency department: a step to move palliative care upstream.
S. Lamba (2009)
Increased access to palliative care and hospice services: opportunities to improve value in health care.
D. Meier (2011)
Care for all at the end of life
S. Murray (2008)
A qualitative study exploring use of the surprise question in the care of older people: perceptions of general practitioners and challenges for practice
M. Elliott (2014)
How common are palliative care needs among older people who die in the emergency department?
T. Beynon (2011)
Content Validation of a Novel Screening Tool to Identify Emergency Department Patients With Significant Palliative Care Needs.
Naomi R George (2015)
The economic and clinical impact of an inpatient palliative care consultation service: a multifaceted approach.
E. Ciemins (2007)
Utility of the "surprise" question to identify dialysis patients with high mortality.
A. Moss (2008)
Implementation and impact of the Gold Standards Framework in community palliative care: a qualitative study of three primary care trusts
C. Walshe (2008)
Internet, mail, and mixed‐mode surveys: The tailored design method
Angela P. Wetzel (2010)
Integration of palliative care into emergency medicine: the Improving Palliative Care in Emergency Medicine (IPAL-EM) collaboration.
S. Lamba (2014)
Evaluation of a hospital-based palliative support service with particular regard to financial outcome measures
B. Axelsson (1998)
Every Patient Is an Individual: Clinicians Balance Individual Factors When Discussing Prognosis with Diverse Frail Elderly Adults
J. Thai (2013)
Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: the Project ENABLE II randomized controlled trial.
Marie Bakitas (2009)
Surprise Questions for Survival Prediction in Patients With Advanced Cancer: A Multicenter Prospective Cohort Study.
J. Hamano (2015)
Prognostic significance of the "surprise" question in cancer patients.
A. Moss (2010)
Older patients’ attitudes towards and experiences of patient-physician end-of-life communication: a secondary analysis of interviews from British, Dutch and Belgian patients
Natalie Evans (2012)
Identifying factors affecting utilization of an inpatient palliative care service: a physician survey.
C. Snow (2009)
Palliative medicine review: prognostication.
P. Glare (2008)
Quality end of life care: the case for a MediCaring demonstration.
J. Lynn (1998)
Five things physicians and patients should question.
Quality end-of-life care: patients' perspectives.
P. Singer (1999)
Hospital charges for a community inpatient palliative care program
J. D. Cowan (2004)
Can we predict which hospitalised patients are in their last year of life? A prospective cross-sectional study of the Gold Standards Framework Prognostic Indicator Guidance as a screening tool in the acute hospital setting
A. O'Callaghan (2014)
Cost and utilization outcomes of patients receiving hospital-based palliative care consultation.
J. Penrod (2006)
Estimating 1year mortality for high-risk primary care patients using the ‘‘surprise’
JR Lakin (2016)
Transitions to palliative care in acute hospitals in England: qualitative study
M. Gott (2011)
WHO Definition of Palliative Care
World Health Organization (2015)
Research priorities for palliative and end-of-life care in the emergency setting.
T. Quest (2011)
Half of older Americans seen in emergency department in last month of life; most admitted to hospital, and many die there.
A. Smith (2012)
Palliative medicine and geriatric emergency care: challenges, opportunities, and basic principles.
Mark Rosenberg (2013)
Self-reported symptom experience of critically ill cancer patients receiving intensive care
J. Nelson (2001)
Proactive palliative care in the medical intensive care unit: Effects on length of stay for selected high-risk patients
S. Norton (2007)
Estimating 1-Year Mortality for High-Risk Primary Care Patients Using the "Surprise" Question.
Joshua R Lakin (2016)
Randomized Controlled Trial of ED-Triggered Palliative Care in Patients with Metastatic Solid Tumors(TH347-C)
C. Grudzen (2015)
Using the ‘surprise question’ can identify people with advanced heart failure and COPD who would benefit from a palliative care approach
S.A. Murray (2011)
The effects of an inpatient palliative care team on discharge disposition.
A. Brody (2010)
A qualitative study: Professionals’ experiences of advance care planning in dementia and palliative care, ‘a good idea in theory but …’
L. Robinson (2013)
Emergency physician response to the surprise question and identification of unmet palliative care needs
AG Bond (2014)
This paper is referenced by
Étude descriptive des pratiques normandes dans la prise en charge des patients en traitement conservateur
Sophie Uteza (2019)
The "Surprise Question" Asked of Emergency Physicians May Predict 12-Month Mortality among Older Emergency Department Patients.
Kei Ouchi (2018)
Predicting one‐year mortality in heart failure using the ‘Surprise Question’: a prospective pilot study
S. Straw (2019)
Initiating palliative care consultation for acute critically ill patients in the emergency department intensive care unit
C. Yang (2020)
How Well Does the Surprise Question Predict 1-year Mortality for Patients Admitted with COPD?
Dana Tripp (2021)
Physicians’ views on the usefulness and feasibility of identifying and disclosing patients’ last phase of life: a focus group study
C. Owusuaa (2021)
A New Standard for Advance Care Planning (ACP) Conversations in the Hospital: Results from a Delphi Panel
Deepika Mohan (2020)
Earlier identification of seriously ill patients: an implementation case series
Joshua R Lakin (2019)
The “Surprise Question” in Neurorehabilitation—Prognosis Estimation by Neurologist and Palliative Care Physician; a Longitudinal, Prospective, Observational Study
M. Ebke (2018)
Association of Emergency Clinicians' Assessment of Mortality Risk With Actual 1-Month Mortality Among Older Adults Admitted to the Hospital
Kei Ouchi (2019)
Impact of palliative care consult service in inpatient hospital setting: a systematic literature review.
E. Janberidze (2020)
Mortality rates in teaching hospital complex care wards in England: a retrospective audit.
A. Burrell (2019)
The Surprise Question Can Be Used to Identify Heart Failure Patients in the Emergency Department Who Would Benefit From Palliative Care.
Emily L Aaronson (2019)
Would You Be Surprised if This Patient Died in the Next 12 Months? Using the Surprise Question to Increase Palliative Care Consults From the Emergency Department
Henry Zeng (2019)
Space for intuition – the ‘Surprise’-Question in haemato-oncology: Qualitative analysis of experiences and perceptions of haemato-oncologists
Christina Gerlach (2019)
Criterion validity and inter-rater reliability of a palliative care screening tool for patients admitted to an emergency department intensive care unit.
Sabrina Corrêa da Costa Ribeiro (2017)
What are the risk factors for avoidable transitions in the last year of life? A qualitative exploration of professionals’ perspectives for improving care in Germany
A. Kasdorf (2021)