title: The 'surprise' question in advanced cancer patients: A prospective study among general practitioners.
abstract: BACKGROUND
  Using the 'surprise' question 'Would you be surprised if this patient died in the next year?' may improve physicians' prognostic accuracy and identify people appropriate for palliative care.
  
  
  OBJECTIVE
  Determine the prognostic accuracy of general practitioners asking the 'surprise' question about their patients with advanced (stage IV) cancer.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Between December 2011 and February 2012, 42 of 50 randomly selected general practitioners (Bologna area, Italy) prospectively classified 231 patients diagnosed with advanced cancer according to the 'surprise' question and supplied the status of each patient 1 year later.
  
  
  RESULTS
  Of the 231 patients, general practitioners responded 'No' to the 'surprise' question for 126 (54.5%) and 'Yes' for 105 (45.5%). After 12 months, 104 (45.0%) patients had died; 87 (83.7%) were in the 'No' group. The sensitivity of the 'surprise' question was 69.3%; the specificity was 83.6%. Positive predictive value was 83.8%; negative predictive value was 69.0%. The answer to the 'surprise' question was significantly correlated with survival at 1 year. Patients in the 'No' group had an odds ratio of 11.55 (95% confidence interval: 5.83-23.28) and a hazard ratio of 6.99 (95% confidence interval: 3.75-13.03) of being dead in the next year compared to patients in the 'Yes' group (p = 0.000 for both odds ratio and hazard ratio).
  
  
  CONCLUSIONS
  When general practitioners used the 'surprise' question for their patients with advanced cancer, the accuracy of survival prognosis was very high. This has clinical potential as a method to identify patients who might benefit from palliative care.
authors.affiliation: "MariaTeresa Chiantore Seràgnoli" Hospice Foundation, Bologna, Italy Academy of Sciences of Palliative Medicine, Bologna, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Moroni
authors.affiliation: Regional Health System, Emilia-Romagna Region, Italy.
authors.forename: Donato
authors.initials: D
authors.lastname: Zocchi
authors.affiliation: "Isabella Seràgnoli" Foundation, Bologna, Italy.
authors.forename: Deborah
authors.initials: D
authors.lastname: Bolognesi
authors.affiliation: Center for Learning Health Care, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Abernethy
authors.affiliation: Pediatric Oncology and Haematology Unit "Lalla Seràgnoli", University of Bologna, S. Orsola Malpighi Hospital, Bologna, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Rondelli
authors.affiliation: Regional Health System, Emilia-Romagna Region, Italy.
authors.forename: Giandomenico
authors.initials: G
authors.lastname: Savorani
authors.affiliation: Regional Health System, Emilia-Romagna Region, Italy.
authors.forename: Marcello
authors.initials: M
authors.lastname: Salera
authors.affiliation: "Giorgio Prodi" Center for Cancer Research, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
authors.forename: Filippo G
authors.initials: FG
authors.lastname: Dall'Olio
authors.affiliation: "Giorgio Prodi" Center for Cancer Research, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Galli
authors.affiliation: Academy of Sciences of Palliative Medicine, Bologna, Italy "Giorgio Prodi" Center for Cancer Research, Alma Mater Studiorum, University of Bologna, Bologna, Italy guido.biasco@unibo.it.
authors.forename: Guido
authors.initials: G
authors.lastname: Biasco
keywords: Prognostic accuracy; general practitioners; palliative care; prognosis; surprise question; terminal illness