Abstract
Abstract
Background:
Physicians consistently overestimate survival for patients with cancer. The “surprise” question—“Would I be surprised if this patient died in the next year?”—improves end-of-life care by identifying patients with a poor prognosis. It has not been previously studied in patients with cancer.
Objective:
To determine the efficacy of the surprise question in patients with cancer.
Design:
Prospective cohort study.
Setting:
Academic cancer center.
Patients:
853 consecutive patients with breast, lung, or colon cancer.
Measurements:
Surprise question classification and patient status at 12 months, alive or dead, by surprise question response.
Results:
Oncologists classified 826 of 853 prospective patients with cancer (97%) with 131 (16%) classified into the “No” group and 695 (84%) into the “Yes” group. In multivariate analysis, a “No” response identified patients with cancer who had a seven times greater hazard of death in the next year compared to patients in the “Yes” group (HR 7.787, p < 0.001).
Limitations:
Single center study.
Conclusion:
The surprise question is a simple, feasible, and effective tool to identify patients with cancer who have a greatly increased risk of 1-year mortality.
Get full access to this article
View all access options for this article.