Abstract
Introduction
The Surprise Question (“Would I be surprised if this patient were to die in the next 12 months?”) helps to identify patients’ who may need palliative care, but its accuracy is limited. Adding a Second Surprise Question (“Would I be surprised if this patient were still alive after 12 months?”), together called the Double Surprise Question, appeared promising.
Aim
To determine which patient – and GP-characteristics influence responses to the Double Surprise Question.
Design
A cross-sectional study of participants, who were invited to complete an online survey with 20 case vignettes. Outcome was what characteristics of the vignettes and of the GPs influence the answers to the Double Surprise Question, using the association between the answers and the estimated chance of dying within one year as a reference. One-way ANOVA and multilevel logistic regression were used. Trial registration: NCT03697213.
Setting/participants
GPs from six European countries.
Results
250 GPs completed the survey. GPs were more likely to answer ‘yes’ to the Second Surprise Question when the estimated chance of dying was higher, the Australian Modified Karnofsky Performance Scale was lower and for patients with cancer compared to organ-failure. GP characteristics did not influence the answer.
Conclusions
This study indicates that the Double Surprise Question is broadly applicable by GPs as no associations were found between measured GP characteristics and responses to the Double Surprise Question. We recommend prospective studies in real-world populations to relate the answers to the Double Surprise Question to actual death to further demonstrate its clinical efficacy.