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“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
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

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.

Type
Original Article
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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References

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