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Screening with the double surprise question to predict deterioration and death: an explorative study
C M M Veldhoven1,2, N Nutma3, W De Graaf4
1Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands. carel.veldhoven@radboudumc.nl.
BMC Palliative Care
|December 29, 2019
Summary
The double surprise question (DSQ) effectively identifies elderly patients needing palliative care. This screening tool helps differentiate patients with varying life expectancies and care needs in general practice.
Area of Science:
- Geriatric Medicine
- Palliative Care
- General Practice Research
Background:
- Early identification of patients requiring palliative care is challenging.
- The standard Surprise Question (SQ1) has limited predictive value.
- A novel Double Surprise Question (DSQ) was developed by adding a second question to SQ1.
Purpose of the Study:
- To evaluate the accuracy of the DSQ in identifying palliative patients in a general practice setting.
- To assess the DSQ's effectiveness in predicting 1-year mortality.
- To explore the DSQ's utility in discriminating between patients with different palliative care needs.
Main Methods:
- Prospective cohort study with retrospective medical record review.
- Involved 292 patients aged ≥75 years in a Dutch general practice.
- Two general practitioners administered SQ1 and SQ2 to assess patients.
Main Results:
- SQ1 identified 161 patients; SQ2 identified 22 of those.
- Within 12 months, 26 patients died; 24 were identified by SQ1 (92% sensitivity).
- Ten patients identified by both SQ1 and SQ2 (42% sensitivity) had more GP contact and discussed palliative care.
Conclusions:
- The DSQ is a feasible and easily applicable screening tool for general practice.
- It effectively predicts patients with high palliative care needs.
- The DSQ helps differentiate patients based on life expectancy and palliative care requirements.
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