Hostname: page-component-cb9f654ff-5kfdg Total loading time: 0 Render date: 2025-09-04T17:12:17.238Z Has data issue: false hasContentIssue false
  • English
  • Français

“The surprise questions” using variable time frames in hospitalized patients with advanced cancer

Published online by Cambridge University Press:  17 June 2021

Sun Hyun Kim Open the ORCID record for Sun Hyun Kim [Opens in a new window] ,
Sang-Yeon Suh Open the ORCID record for Sang-Yeon Suh [Opens in a new window] ,
Seok Joon Yoon ,
Jeanno Park ,
Yu Jung Kim ,
Beodeul Kang ,
Youngmin Park ,
Jung Hye Kwon ,
Kwonoh Park  and
Jung-Young Kim
...Show all authors
Sun Hyun Kim
Affiliation:
Department of Family Medicine, School of Medicine, Catholic Kwandong University International St. Mary's Hospital, Incheon, South Korea
Sang-Yeon Suh*
Affiliation:
Department of Family Medicine, Palliative Care Center, Dongguk University Ilsan Hospital, Goyang, South Korea Department of Medicine, School of Medicine, Dongguk University, Seoul, South Korea
Seok Joon Yoon
Affiliation:
Department of Family Medicine, School of Medicine, Chungnam National University, Daejeon, South Korea
Jeanno Park
Affiliation:
Department of Internal Medicine, Bobath Hospital, Seongnam, South Korea
Yu Jung Kim
Affiliation:
Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
Beodeul Kang
Affiliation:
Division of Medical Oncology, Bundang Medical Center, CHA University, Seongnam, South Korea
Youngmin Park
Affiliation:
Department of Family Medicine, National Health Insurance Service Ilsan Hospital, Goyang, South Korea
Jung Hye Kwon
Affiliation:
Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, South Korea
Kwonoh Park
Affiliation:
Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan, South Korea
Jung-Young Kim
Affiliation:
Department of Nursing, Catholic Kwandong University International St. Mary's Hospital, Incheon, South Korea
Hana Choi
Affiliation:
Department of Statistics, Dongguk University, Seoul, South Korea
Hong-Yup Ahn
Affiliation:
Department of Statistics, Dongguk University, Seoul, South Korea
Jun Hamano
Affiliation:
Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
David Hui
Affiliation:
Department of Palliative Care and Rehabilitation Medicine, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
*
Author for correspondence: Sang-Yeon Suh, Department of Medicine, School of Medicine, Dongguk University, Seoul, South Korea. E-mail: lisasuhmd@hotmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

Several studies supported the usefulness of “the surprise question” in terms of 1-year mortality of patients. “The surprise question” requires a “Yes” or “No” answer to the question “Would I be surprised if this patient died in [specific time frame].” However, the 1-year time frame is often too long for advanced cancer patients seen by palliative care personnel. “The surprise question” with shorter time frames is needed for decision making. We examined the accuracy of “the surprise question” for 7-day, 21-day, and 42-day survival in hospitalized patients admitted to palliative care units (PCUs).

Method

This was a prospective multicenter cohort study of 130 adult patients with advanced cancer admitted to 7 hospital-based PCUs in South Korea. The accuracy of “the surprise question” was compared with that of the temporal question for clinician's prediction of survival.

Results

We analyzed 130 inpatients who died in PCUs during the study period. The median survival was 21.0 days. The sensitivity, specificity, and overall accuracy for the 7-day “the surprise question” were 46.7, 88.7, and 83.9%, respectively. The sensitivity, specificity, and overall accuracy for the 7-day temporal question were 6.7, 98.3, and 87.7%, respectively. The c-indices of the 7-day “the surprise question” and 7-day temporal question were 0.662 (95% CI: 0.539–0.785) and 0.521 (95% CI: 0.464–0.579), respectively. The c-indices of the 42-day “the surprise question” and 42-day temporal question were 0.554 (95% CI: 0.509–0.599) and 0.616 (95% CI: 0.569–0.663), respectively.

Significance of results

Surprisingly, “the surprise questions” and temporal questions had similar accuracies. The high specificities for the 7-day “the surprise question” and 7- and 21-day temporal question suggest they may be useful to rule in death if positive.

Keywords

Far advanced cancerPalliative carePrognosisSurprise questionSurvival

Information

Type
Original Article
Information
Palliative & Supportive Care , Volume 20 , Issue 2 , April 2022 , pp. 221 - 225
Check for updates
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

REFERENCES

Amano, K, Maeda, I, Shimoyama, S, et al. (2015) The accuracy of physicians’ clinical predictions of survival in patients with advanced cancer. Journal of Pain and Symptom Management 50(2), 139–146.e131.CrossRefGoogle ScholarPubMed
Christakis, NA and Lamont, EB (2000) Extent and determinants of error in doctors’ prognoses in terminally ill patients: Prospective cohort study. BMJ 320(7233), 469–472.CrossRefGoogle ScholarPubMed
Downar, J, Goldman, R, Pinto, R, et al. (2017) The “surprise question” for predicting death in seriously ill patients: A systematic review and meta-analysis. CMAJ 189(13), E484–E493.CrossRefGoogle Scholar
Ekstrom, M, Vergo, MT, Ahmadi, Z, et al. (2016) Prevalence of sudden death in palliative care: Data from the Australian palliative care outcomes collaboration. Journal of Pain and Symptom Management 52(2), 221–227.CrossRefGoogle ScholarPubMed
Gwilliam, B, Keeley, V, Todd, C, et al. (2011) Development of prognosis in palliative care study (PiPS) predictor models to improve prognostication in advanced cancer: Prospective cohort study. BMJ 343, d4920.CrossRefGoogle ScholarPubMed
Hamano, J, Morita, T, Inoue, S, et al. (2015) Surprise questions for survival prediction in patients with advanced cancer: A multicenter prospective cohort study. The Oncologist 20(7), 839–844.CrossRefGoogle Scholar
Harrell, FE Jr, Lee, KL and Mark, DB (1996) Multivariable prognostic models: Issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Statistics in Medicine 15(4), 361–387.3.0.CO;2-4>CrossRefGoogle ScholarPubMed
Hui, D (2015) Prognostication of survival in patients with advanced cancer: Predicting the unpredictable? Cancer Control: Journal of the Moffitt Cancer Center 22(4), 489–497.CrossRefGoogle ScholarPubMed
Hui, D, Bansal, S, Morgado, M, et al. (2014a) Phase angle for prognostication of survival in patients with advanced cancer: Preliminary findings. Cancer 120(14), 2207–2214.CrossRefGoogle ScholarPubMed
Hui, D, dos Santos, R, Chisholm, G, et al. (2014b) Clinical signs of impending death in cancer patients. The Oncologist 19(6), 681–687.CrossRefGoogle ScholarPubMed
Hui, D, Moore, J, Park, M, et al. (2019a) Phase angle and the diagnosis of impending death in patients with advanced cancer: Preliminary findings. The Oncologist 24(6), e365–e373.CrossRefGoogle ScholarPubMed
Hui, D, Paiva, CE, Del Fabbro, EG, et al. (2019b) Prognostication in advanced cancer: Update and directions for future research. Supportive Care in Cancer 27(6), 1973–1984.CrossRefGoogle ScholarPubMed
Hyodo, I, Morita, T, Adachi, I, et al. (2010) Development of a predicting tool for survival of terminally ill cancer patients. Japanese Journal of Clinical Oncology 40(5), 442–448.CrossRefGoogle ScholarPubMed
Jho, HJ, Suh, SY, Yoon, SJ, et al. (2016) Prospective validation of the objective prognostic score for advanced cancer patients in diverse palliative settings. Journal of Pain and Symptom Management 52(3), 420–427.CrossRefGoogle ScholarPubMed
Kao, S, Shafiq, J, Vardy, J, et al. (2009) Use of chemotherapy at end of life in oncology patients. Annals of Oncology 20(9), 1555–1559.CrossRefGoogle ScholarPubMed
Morita, T, Tsunoda, J, Inoue, S, et al. (1999) The palliative prognostic index: A scoring system for survival prediction of terminally ill cancer patients. Supportive Care in Cancer 7(3), 128–133.CrossRefGoogle ScholarPubMed
Moroni, M, Zocchi, D, Bolognesi, D, et al. (2014) The “surprise” question in advanced cancer patients: A prospective study among general practitioners. Palliative Medicine 28(7), 959–964.CrossRefGoogle Scholar
Moss, AH, Lunney, JR, Culp, S, et al. (2010) Prognostic significance of the “surprise” question in cancer patients. Journal of Palliative Medicine 13(7), 837–840.CrossRefGoogle ScholarPubMed
Pattison, M and Romer, AL (2001) Improving care through the end of life: Launching a primary care clinic-based program. Journal of Palliative Medicine 4(2), 249–254.CrossRefGoogle ScholarPubMed
Perez-Cruz, PE, Dos Santos, R, Silva, TB, et al. (2014) Longitudinal temporal and probabilistic prediction of survival in a cohort of patients with advanced cancer. Journal of Pain and Symptom Management 48(5), 875–882.CrossRefGoogle Scholar
Pirovano, M, Maltoni, M, Nanni, O, et al. (1999) A new palliative prognostic score: A first step for the staging of terminally ill cancer patients. Italian Multicenter and Study Group on Palliative Care. Journal of Pain and Symptom Management 17(4), 231–239.CrossRefGoogle Scholar
Scarpi, E, Maltoni, M, Miceli, R, et al. (2011) Survival prediction for terminally ill cancer patients: Revision of the palliative prognostic score with incorporation of delirium. The Oncologist 16(12), 1793–1799.CrossRefGoogle ScholarPubMed
Shin, DW, Suh, SY, Kim, SH, et al. (2018) Is spirituality related to survival in advanced cancer inpatients in Korea? Palliative & Supportive Care 16(6), 669–676.CrossRefGoogle ScholarPubMed
Stiel, S, Bertram, L, Neuhaus, S, et al. (2010) Evaluation and comparison of two prognostic scores and the physicians’ estimate of survival in terminally ill patients. Supportive Care in Cancer 18(1), 43–49.CrossRefGoogle ScholarPubMed
Subramaniam, S, Thorns, A, Ridout, M, et al. (2015) Accuracy of prognosis prediction by PPI in hospice inpatients with cancer: A multi-centre prospective study. BMJ Supportive & Palliative Care 5(4), 399–404.CrossRefGoogle Scholar
Suh, SY, Choi, YS, Shim, JY, et al. (2010) Construction of a new, objective prognostic score for terminally ill cancer patients: A multicenter study. Supportive Care in Cancer 18(2), 151–157.CrossRefGoogle ScholarPubMed
Vigano, A, Dorgan, M, Bruera, E, et al. (1999) The relative accuracy of the clinical estimation of the duration of life for patients with end of life cancer. Cancer 86(1), 170–176.3.0.CO;2-S>CrossRefGoogle ScholarPubMed
Weeks, JC, Cook, EF, O'Day, SJ, et al. (1998) Relationship between cancer patients’ predictions of prognosis and their treatment preferences. JAMA 279, 1709–1714.CrossRefGoogle ScholarPubMed
White, N, Kupeli, N, Vickerstaff, V, et al. (2017) How accurate is the “surprise question” at identifying patients at the end of life? A systematic review and meta-analysis. BMC Medical 15(1), 139.CrossRefGoogle ScholarPubMed
Yoon, HS, Kim, CM, Lee, YY, et al. (2015) Clinical prediction of survival in terminal cancer patients: Individual assessment vs. Interdisciplinary assessment. Korean The Journal of Family Practice 5(2), 89–94.Google Scholar
Yoon, SJ, Suh, SY, Lee, YJ, et al. (2017) Prospective validation of objective prognostic score for advanced cancer inpatients in South Korea: A multicenter study. Journal of Palliative Medicine 20(1), 65–68.CrossRefGoogle ScholarPubMed