title: Prognostic significance of the "surprise" question in cancer patients.
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.
  
  
  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.
authors.affiliation: West Virginia University, Morgantown, West Virginia 26506, USA. amoss@hsc.wvu.edu
authors.forename: Alvin H
authors.initials: AH
authors.lastname: Moss
authors.forename: June R
authors.initials: JR
authors.lastname: Lunney
authors.forename: Stacey
authors.initials: S
authors.lastname: Culp
authors.forename: Miklos
authors.initials: M
authors.lastname: Auber
authors.forename: Sobha
authors.initials: S
authors.lastname: Kurian
authors.forename: John
authors.initials: J
authors.lastname: Rogers
authors.forename: Joshua
authors.initials: J
authors.lastname: Dower
authors.forename: Jame
authors.initials: J
authors.lastname: Abraham
mesh_terms: 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