The Surprise Question and Serious Illness Conversations: A pilot study.

Area of Science:

• Medical Ethics
• Palliative Care
• Health Services Research

Background:

• Serious Illness Conversations are crucial for aligning patient care with their goals.
• Critically ill patients on acute medicine units often receive interventions without prior goal-setting discussions.
• This highlights a gap in timely and appropriate end-of-life care planning.

Purpose of the Study:

• To assess the feasibility of using the Surprise Question to identify patients needing early Serious Illness Conversations.
• To evaluate changes in healthcare professionals' beliefs, confidence, and engagement regarding these conversations.
• To explore the utility of the Surprise Question as a screening tool in acute care settings.

Main Methods:

• A prospective cohort pilot study utilizing two Plan-Do-Study-Act cycles.
• Fifty-eight healthcare professionals completed pre- and post-intervention questionnaires.
• The intervention involved asking the Surprise Question for each patient, with chart reviews for Serious Illness Conversation documentation.

Main Results:

• Healthcare professionals showed equivocal changes in beliefs, confidence, and engagement.
• Six out of 23 patients were flagged for Serious Illness Conversations, with some evidence of increased documentation.
• Difficulties were noted in directly equating the Surprise Question's response to the need for a Serious Illness Conversation.

Conclusions:

• Identifying patients for Serious Illness Conversations is a professional and ethical nursing duty.
• Flagging patients can help prioritize conversations, but defining "serious illness" and the question's implications requires clarification.
• Addressing time constraints and training needs requires institutional commitment to support these vital discussions.