“The surprise questions” using variable time frames in hospitalized patients with advanced cancer

Objective Several studies supported the usefulness of the surprise question in terms of 1-year mortality of patients. The surprise question requires a Yes or No answer to the question Would I be surprised if this patient died in [specific time frame]. However, the 1-year time frame is often too long for advanced cancer patients seen by palliative care personnel. The surprise question with shorter time frames is needed for decision making. We examined the accuracy of the surprise question for 7-day, 21-day, and 42-day survival in hospitalized patients admitted to palliative care units (PCUs). Method This was a prospective multicenter cohort study of 130 adult patients with advanced cancer admitted to 7 hospital-based PCUs in South Korea. The accuracy of the surprise question was compared with that of the temporal question for clinician's prediction of survival. Results We analyzed 130 inpatients who died in PCUs during the study period. The median survival was 21.0 days. The sensitivity, specificity, and overall accuracy for the 7-day the surprise question were 46.7, 88.7, and 83.9%, respectively. The sensitivity, specificity, and overall accuracy for the 7-day temporal question were 6.7, 98.3, and 87.7%, respectively. The c-indices of the 7-day the surprise question and 7-day temporal question were 0.662 (95% CI: 0.539-0.785) and 0.521 (95% CI: 0.464-0.579), respectively. The c-indices of the 42-day the surprise question and 42-day temporal question were 0.554 (95% CI: 0.509-0.599) and 0.616 (95% CI: 0.569-0.663), respectively. Significance of results Surprisingly, the surprise questions and temporal questions had similar accuracies. The high specificities for the 7-day the surprise question and 7- and 21-day temporal question suggest they may be useful to rule in death if positive.