1 III. Department of Medicine, Interdisciplinary Department of Palliative Care, University Medical Center, Johannes Gutenberg University of Mainz, Mainz, Germany.
2 Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Germany.
Palliat Med. 2019 May;33(5):531-540. doi: 10.1177/0269216318824271. Epub 2019 Jan 28.
Early integration of palliative care can improve outcomes for people with cancer and non-cancer diagnoses. However, prediction of survival for individuals is challenging, in particular in patients with haematological malignancies who are known to have limited access to palliative care. The 'Surprise'-Question can be used to facilitate referral to palliative care.
To explore experiences, views and perceptions of haemato-oncologists on the use of the 'Surprise'-Question in the haemato-oncology outpatients clinics of a university hospital in Germany.
A qualitative study using individual semi-structured interviews transcribed verbatim and analysed thematically based on the framework approach.
SETTING/PARTICIPANTS: The study took place at the haemato-oncology outpatient clinic and the bone marrow transplantation outpatient clinic of a university hospital. Nine haemato-oncologists participated in qualitative interviews.
Thematic analysis identified 4 themes and 11 subthemes: (1) meaning and relevance of the 'Surprise'-Question; (2) feasibility; (3) the concept of 'surprise' and (4) personal aspects of prognostication. A key function of the 'Surprise'-Question was to stimulate intuition and promote patient-centred goals of care by initiating a process of pause → reflection → change of perspective. It was easy and quick to use, but required time and communication skills to act on. Participants' training in palliative care enhanced their willingness to use the 'Surprise'-Question.
Irrespective of its use in prognostication, the 'Surprise'-Question is a valuable tool to facilitate consideration of patient-centred goals and promote holistic care in haemato-oncology. However, prognostic uncertainty, lack of time and communication skills are barriers for integration into daily practice. Further research should involve haematology patients to integrate their needs and preferences.
早期姑息治疗可以改善癌症和非癌症患者的预后。然而，个体的生存预测具有挑战性，特别是在血液恶性肿瘤患者中，他们通常难以获得姑息治疗。“Surprise”问题可以用来促进姑息治疗的转诊。
探讨德国一所大学医院血液肿瘤科门诊血液科医生对使用“Surprise”问题的经验、看法和看法。
一项定性研究，采用个体半结构化访谈，根据框架方法进行主题分析。
设置/参与者：该研究在一所大学医院的血液肿瘤科门诊和骨髓移植门诊进行。9 名血液科医生参与了定性访谈。
主题分析确定了 4 个主题和 11 个子主题：（1）“Surprise”问题的意义和相关性；（2）可行性；（3）“Surprise”的概念；（4）预后的个人方面。“Surprise”问题的一个关键功能是通过启动暂停→反思→改变观点的过程来刺激直觉并促进以患者为中心的护理目标。它使用起来既简单又快捷，但需要时间和沟通技巧来实施。参与者在姑息治疗方面的培训增强了他们使用“Surprise”问题的意愿。
无论是否用于预后，“Surprise”问题都是促进考虑以患者为中心的目标和促进血液肿瘤学整体护理的有价值的工具。然而，预后的不确定性、缺乏时间和沟通技巧是将其纳入日常实践的障碍。进一步的研究应涉及血液学患者，以整合他们的需求和偏好。
