The surprise question (SQ) was developed more than a decade ago and has been suggested as a simple test to identify patients who might benefit from hospice and palliative care (HPC). It implicates a clinician reflecting on the question, “Would I be surprised if this patient died in the next 12 months?”
The SQ is intended to be a simple and practicable screening test to identify patients with palliative care needs, but it performs poorly to modestly when used to predict death at 6 to 18 months, with poorer performance among patients with non-cancer illness.
Based on these findings, the SQ should not be used as a stand-alone prognostic tool, and it is know whether it is more accurate to identify patients with unmet palliative needs than it is for those in the final year of life.
The high false-positive rate for SQ may be of concern if it used as a routine trigger for time-consuming, costly or poorly available assessments for hospice and palliative care. Developing accurate, reliable and automated means of identifying patients with hospice and palliative care needs in a variety of settings remains a high-priority area of research.
The SQ has been widely promoted and adopted into frameworks for assessing hospice and palliative care needs.
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Adapted from Downar J et al. The “surprise question” for predicting death in seriously ill patients: a systematic review and meta-analysis. Internet. Available at http://www.cmaj.ca/content/189/13/E484. Accessed on June 19, 2018