Prognostic significance of the "surprise" question in cancer patients.
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.


METHODS
Prospective cohort study.


METHODS
Academic cancer center.


METHODS
853 consecutive patients with breast, lung, or colon cancer.


METHODS
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).


CONCLUSIONS
Single center study.


CONCLUSIONS
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.
Moss
Alvin H
AH
West Virginia University, Morgantown, West Virginia 26506, USA. amoss@hsc.wvu.edu
Lunney
June R
JR
Culp
Stacey
S
Auber
Miklos
M
Kurian
Sobha
S
Rogers
John
J
Dower
Joshua
J
Abraham
Jame
J
D016223:Advance Directives; D000368:Aged; D001291:Attitude of Health Personnel; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007600:Judgment; D008297:Male; D018447:Medical Futility; D008495:Medical Oncology / Q000379:methods* / Q000592:standards; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis* / Q000628:therapy; D010166:Palliative Care / Q000379:methods* / Q000592:standards; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013727:Terminal Care / Q000379:methods* / Q000592:standards; D014903:West Virginia