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Accuracy of the Surprise Question on an Inpatient Oncology Service

A Multidisciplinary Perspective

Singh, Sarguni MD; Graham, Zachary MD; Rodriguez, Adrian BSN; Lee, Darrell BSN; Wenger, Barbara DNP; Min, Sung-Joon PhD; Fischer, Stacy MD

Journal of Hospice & Palliative Nursing: August 2019 - Volume 21 - Issue 4 - p 300–304
doi: 10.1097/NJH.0000000000000558
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The surprise question (SQ), “Would you be surprised if your patient died within a year?”, has been studied in the cancer population as a prognostic prompt. Studies have almost exclusively directed the SQ to physicians, whereas perspectives of nurses remain underevaluated. We asked the SQ for patients admitted to an inpatient medical oncology service to medical oncology, palliative care, and hospital medicine teams and bedside nurses. We performed a 1-year retrospective chart review to identify how concordant various provider types were in their prognostic estimations and identified the missed opportunity rate (MOR) defined as the number of patients who died within a particular time frame but who the providers had predicted would be alive and may not have had a palliative approach. Oncologists had higher MORs for the 6-month and 1-year SQ when compared with hospital medicine providers. Bedside nurses were least concordant in their estimations of prognosis and had higher MORs for all time frames of the SQ. Missed opportunities might have significant implications for the end-of-life care for cancer patients, and continued research is needed to understand what influences provider prognostication and how this impacts palliative care utilization for patients with life-limiting disease.

Sarguni Singh, MD, is assistant professor, Division of Hospital Medicine, University of Colorado Denver, Colorado.

Zachary Graham, MD, is internal medicine resident, Division of General Internal Medicine, University of Colorado Denver, Aurora.

Adrian Rodriguez, BSN, is clinical nurse specialist student, College of Nursing, University of Colorado Denver, Aurora.

Darrell Lee, BSN, is clinical nurse specialist student, College of Nursing, University of Colorado Denver, Aurora.

Barbara Wenger, DNP, is Oncology/BMT/Gyn-Onc clinical nurse specialist, College of Nursing, University of Colorado Denver, Aurora.

Sung-Joon Min, PhD, is associate professor, Division of Health Care Policy & Research, University of Colorado Denver, Aurora.

Stacy Fischer, MD, is associate professor, Division of General Internal Medicine, University of Colorado Denver, Aurora.

Address correspondence to Sarguni Singh, MD, Leprino Building, 4th Floor, 12401 E 17th Ave, Mailstop F-782, Aurora, CO 80045 (sarguni.singh@ucdenver.edu).

The authors have no conflicts of interest to disclose.

Online date: April 1, 2019

© 2019 by The Hospice and Palliative Nurses Association.