Feb 1, 2022
This episode features Dr Nicola White (Marie Curie Palliative
Care Research Department, Division of Psychiatry, University
College London, London, UK), Dr Christina Gerlach (University
Medical Center Hamburg-Eppendorf, Hamburg, Germany), Dr Bert Leysen
(Department of Metabolism, Digestion and Reproduction, Faculty
of Medicine, Imperial College London, London, UK) and Prof Yvonne
Engels (Anesthesiology, Pain and Palliative Medicine, Radboud
University Medical Centre, Nijmegen, The Netherlands).
The Surprise Question (‘Would I be surprised if this patient died
within 12 months?’) is a screening tool which is used to identify
patients with palliative care needs. The Surprise Question alone is
not a very accurate way to prognosticate. It is not known
whether prognostication with the Surprise Question is difficult
because clinicians are intrinsically poor prognosticators, because
the Surprise Question is interpreted in different ways by
different clinicians, of because clinicians themselves are
inconsistent in their level of surprise.
Our study suggests that the threshold probability, before a death
causes surprise, varies across six European countries. Many GPs
(including those with specialist palliative care training) are
inconsistent about the probability of death that elicits
surprise.
Further research is needed to understand how the Surprise Question
is used in practice, and whether consistency and accuracy could be
improved by modifying the Surprise Question, or by training GPs in
its use.