Are Surprise Questions and Probabilistic Questions by Nurses Useful in Home Palliative Care? A Prospective Study

Area of Science:

• Palliative Care and Geriatric Medicine
• Oncology and Cancer Prognosis
• Nursing and Clinical Assessment

Background:

• Surprise questions (SQs) and probabilistic questions (PQs) are utilized for screening in palliative care.
• While PQs demonstrate higher accuracy than temporal predictions, the utility of SQs and PQs by nurses remains understudied.
• Accurate prognostic assessment is crucial for optimizing care in advanced cancer patients receiving home palliative care.

Purpose of the Study:

• To evaluate the accuracy of nurses' assessments using surprise questions (SQs) and probabilistic questions (PQs) in advanced cancer patients.
• To determine the prognostic value of SQs and PQs in the context of home palliative care.
• To compare the performance of SQs and PQs at various timeframes (1, 2, 4, and 6 weeks).

Main Methods:

• A prospective, single-center cohort study was conducted with adult patients receiving home palliative care for advanced cancer.
• Palliative care nurses assessed patients using SQs ('Would you be surprised if the patient died within X timeframe?') and PQs ('What is the probability the patient will be alive within X timeframe?').
• Sensitivity, specificity, and overall accuracy were calculated for both SQ and PQ at 1, 2, 4, and 6-week intervals.

Main Results:

• Eighty-one patients were enrolled, with a median survival of 47 days.
• At 1 week, the SQ achieved 50.0% sensitivity, 93.2% specificity, and 88.9% overall accuracy; the PQ achieved 12.5% sensitivity, 100.0% specificity, and 91.3% overall accuracy.
• At 6 weeks, the SQ showed 84.6% sensitivity, 42.9% specificity, and 62.9% overall accuracy; the PQ showed 59.0% sensitivity, 66.7% specificity, and 63.0% overall accuracy. PQs consistently demonstrated higher specificity than SQs across all timeframes.

Conclusions:

• Both surprise questions (SQs) and probabilistic questions (PQs) demonstrated acceptable accuracy in assessing prognosis for home palliative care patients.
• Probabilistic questions (PQs) exhibited higher specificity compared to surprise questions (SQs) at all evaluated timeframes.
• Nurse-led SQs and PQs can serve as valuable tools for providing supplementary prognostic information in home palliative care settings.