An online international comparison of palliative care identification in primary care using the Surprise Question.

White, Nicola; Oostendorp, Linda Jm; Vickerstaff, Victoria; Gerlach, Christina; Engels, Yvonne; Maessen, Maud; Tomlinson, Christopher; Wens, Johan; Leysen, Bert; Biasco, Guido; Zambrano, Sofia; Eychmüller, Steffen; Avgerinou, Christina; Chattat, Rabih; Ottoboni, Giovanni; Veldhoven, Carel; Stone, Patrick (2021). An online international comparison of palliative care identification in primary care using the Surprise Question. (In Press). Palliative medicine, p. 2692163211048340. Sage 10.1177/02692163211048340

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BACKGROUND

The Surprise Question ('Would I be surprised if this patient died within 12 months?') identifies patients in the last year of life. It is unclear if 'surprised' means the same for each clinician, and whether their responses are internally consistent.

AIM

To determine the consistency with which the Surprise Question is used.

DESIGN

A cross-sectional online study of participants located in Belgium, Germany, Italy, The Netherlands, Switzerland and UK. Participants completed 20 hypothetical patient summaries ('vignettes'). Primary outcome measure: continuous estimate of probability of death within 12 months (0% [certain survival]-100% [certain death]). A threshold (probability estimate above which Surprise Question responses were consistently 'no') and an inconsistency range (range of probability estimates where respondents vacillated between responses) were calculated. Univariable and multivariable linear regression explored differences in consistency. Trial registration: NCT03697213.

SETTING/PARTICIPANTS

Registered General Practitioners (GPs). Of the 307 GPs who started the study, 250 completed 15 or more vignettes.

RESULTS

Participants had a consistency threshold of 49.8% (SD 22.7) and inconsistency range of 17% (SD 22.4). Italy had a significantly higher threshold than other countries (p = 0.002). There was also a difference in threshold levels depending on age of clinician, for every yearly increase, participants had a higher threshold. There was no difference in inconsistency between countries (p = 0.53).

CONCLUSIONS

There is variation between clinicians regarding the use of the Surprise Question. Over half of GPs were not internally consistent in their responses to the Surprise Question. Future research with standardised terms and real patients is warranted.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Medical Oncology
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)

UniBE Contributor:

Maessen, Maud; Zambrano Ramos, Sofia Carolina and Eychmüller, Steffen

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

1477-030X

Publisher:

Sage

Language:

English

Submitter:

Andrea Flükiger-Flückiger

Date Deposited:

08 Oct 2021 15:38

Last Modified:

10 Oct 2021 06:53

Publisher DOI:

10.1177/02692163211048340

PubMed ID:

34596445

Uncontrolled Keywords:

Prognosis palliative care primary health care survival

BORIS DOI:

10.48350/159854

URI:

https://boris.unibe.ch/id/eprint/159854

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