Abstract
BackgroundIn our aging society, palliative care should be a standard component of health care. However, currently it is only provided to a small proportion of patients, mostly to those with cancer, and restricted to the terminal phase. Many general practitioners (GPs) say that one of their most significant challenges is to assess the right moment to start anticipatory palliative care. The “Surprise Question” (SQ1: “Would I be surprised if this patient were to die in the next 12 months”?), if answered with “no”, is an easy tool to apply in identifying patients in need of palliative care. However, this tool has a low specificity. Therefore, the aim of our pilot study was to determine if adding a second, more specific “Surprise Question” (SQ2: “Would I be surprised if this patient is still alive after 12 months”?) in case SQ1 is answered in the negative, prompts GPs to plan for anticipatory palliative care.MethodsBy randomization, 28 GPs in the south-eastern part of the Netherlands were allocated to three different groups. They all received a questionnaire with four vignettes, respectively representing patients with advanced organ failure (A), end stage cancer (B), frailty (C), and recently diagnosed cancer (D). GPs in the first group did not receive additional information, the second group received SQ1 after each vignette, and the third group received SQ1 and SQ2 after each vignette. We rated their answers based on essential components of palliative care (here called RADIANT score).ResultsGPs in group 3 gave higher RADIANT scores to those vignettes in which they would be surprised if the patients were still alive after 12 months. In all groups, vignette B had the highest mean RADIANT score, followed by vignettes A and C, and the lowest on vignette D. Seventy-one percent of GPs in groups 2 and 3 considered SQ1 a helpful tool, and 75% considered SQ2 helpful.ConclusionsThis innovative pilot study indicates that the majority of GPs think SQ2 is a helpful additional tool. The combination of the two “Surprise Questions” encourages GPs to make more specific plans for anticipatory palliative care.
Highlights
In our aging society, palliative care should be a standard component of health care
A way to assess the right moment to start palliative care that costs little time is the “Surprise Question” (SQ): “Would I be surprised if this patient were to die in the 12 months?”
In order to prevent socially desirable answering, we told participating general practitioner (GP) that the purpose of the study was to explore the influence of the type of patient illness on GP’s care planning, without mentioning that we were interested in the influence of the SQs
Summary
Palliative care should be a standard component of health care. currently it is only provided to a small proportion of patients, mostly to those with cancer, and restricted to the terminal phase. The “Surprise Question” (SQ1: “Would I be surprised if this patient were to die in the 12 months”?), if answered with “no”, is an easy tool to apply in identifying patients in need of palliative care. Most patients in an advanced stage of a life-limiting disease live at home in the Netherlands, where the general practitioner (GP) acts as a gatekeeper and coordinator of caregiving This makes the GP the appropriate health care professional to coordinate palliative care [9]. Most tools contain many items and are timeconsuming to apply, when time is at a premium [13,14,15]
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