BACKGROUND

The Surprise Question (" ) is widely used to identify palliative patients, though with low predictive value. To improve timely identification of palliative care needs, we propose an additional Surprise Question (" ) if the original Surprise Question is answered with "no." The combination of the two questions is called the Double Surprise Question.

AIM

To examine the prognostic accuracy of the Double Surprise Question in outpatients with cancer.

DESIGN

A prospective study.

PARTICIPANTS

Twelve medical oncologists completed the Double Surprise Question for 379 patients.

RESULTS

In group 1 (original Surprise Question "yes": surprised if dead) 92.1% (176/191) of the patients were still alive after 1 year, in group 2a (original and additional Surprise Question "no": not surprised if dead and not surprised if alive) 60.0% (63/105), and in group 2b (original Surprise Question "no," additional Surprise Question "yes": surprised if alive) 26.5% (22/83) ( < 0.0001). The positive predictive value increased by using the Double Surprise Question; 74% (61/83) vs 55% (103/188). Anticipatory palliative care provision and Advance Care Planning items were most often documented in group 2b.

CONCLUSIONS

The Double Surprise Question is a promising tool to more accurately identify outpatients with cancer at risk of dying within 1 year, and therefore, those in need of palliative care. Studies should reveal whether the implementation of the Double Surprise Question leads to more timely palliative care.