The Surprise Question Is Not Correlated with Increases in Advance Care Planning Documentation (QI713)

Abstract

1.Describe the influence of the surprise question on advance care planning.2.Discuss how primary care physicians view the surprise question. A positive surprise question (SQ) indicates the provider would not be surprised if the patient died in the next year. The SQ has been proposed as a prompt for advance care planning (ACP). Primary: to evaluate whether a positive SQ correlated with increased ACP. Secondary: to understand how primary care providers (PCPs) think about the SQ. We performed a retrospective chart review of patients cared for at seven PCP practices who died in 2017 and were hospitalized in their last year of life. For our secondary objective, we surveyed PCPs to understand their opinions regarding the SQ. 226 patients died in 2017 and had an SQ answer. About ½ of these patients were male, most were 50 or older (90%), white (97%) and insured by Medicare (83%). 158 (70%) were SQ+; there were no differences in patient characteristics between SQ+ and SQ- patients. There was no association between SQ answer and ACP (65% for SQ+ vs 60% for SQ-, p 0.48). Patients seen by palliative care were more likely to have ACP, a difference which persisted after adjustment for demographic factors and SQ answer (OR 3.89, 95% CI 2.06-7.37). Given the lack of correlation between SQ and ACP, we surveyed PCPs. 61 of 165 (37%) of PCPs responded. Of them, 60% were female, 53% were attendings, and 55% work in both inpatient and outpatient settings. 87% felt the SQ should trigger ACP discussions and 74% felt inpatient providers could accurately answer the SQ about their patients. We found that PCPs believe the SQ is accurate and should prompt ACP. However, we did not find an association between the SQ and ACP. Patients seen by palliative care were more likely to have ACP documentation. Further research is needed to determine if the SQ should continue to be used to prompt ACP.