Gerlach Christina, Weber Martin, Schmidtmann Irene
Department of Palliative Medicine, Heidelberg University Hospital, 69120 Heidelberg, Germany.
Interdisciplinary Department of Palliative Care, III. Medical Clinic & Polyclinic, University Medical Center Mainz, 55131 Mainz, Germany.
Cancers (Basel). 2025 Apr 15;17(8):1326. doi: 10.3390/cancers17081326.
BACKGROUND/OBJECTIVES: Patients with haematological malignancies less frequently receive specialist palliative care, although they may have unmet needs for symptom control and alleviating psychosocial and existential burdens. The 'Surprise' Question, 'Would you be surprised if this patient died in the next 12 months?', helps physicians to identify patients who may benefit from palliative care. We tested the influencing factors of the feasibility of the 'Surprise' Question in haemato-oncology outpatients.
We performed a prospective cohort study comparing patients with solid tumours and haematological malignancies. All the patients in the haemato-oncology outpatient clinics of a German university hospital were screened by haemato-oncologists using the 'Surprise' Question.
A survival analysis was performed on 672 patients (76% with haematological malignancies) at 3 and 12 months. Within one year, 110 patients (16%) died. Of these, 30/52 (58%) were patients with solid tumours, but only 12/53 (23%) patients with haematological malignancies were identified in advance by the 'Surprise' Question, which reflects ambiguous test sensitivity. A substantial part of the haematology patients in their last year of life were not identified (77%). The match between the survival estimates and actual outcomes was fair (Cohen's kappa 0.37). The proximity from prediction to event and the estimating physician rather than patient characteristics influenced the accuracy of the instrument.
For the first time, the feasibility of the 'Surprise' Question in haematology outpatients was proven. Factors that would improve haemato-oncologists' clinical intuition should be further explored to facilitate timely conversations about issues important to patients nearing the end of life.
背景/目的：血液系统恶性肿瘤患者较少接受专科姑息治疗，尽管他们在症状控制以及缓解心理社会和生存负担方面可能存在未满足的需求。“意外”问题，即“如果该患者在未来12个月内死亡，您会感到意外吗？”，有助于医生识别可能从姑息治疗中获益的患者。我们测试了血液肿瘤门诊患者中“意外”问题可行性的影响因素。
我们进行了一项前瞻性队列研究，比较实体肿瘤患者和血液系统恶性肿瘤患者。德国一家大学医院血液肿瘤门诊的所有患者均由血液肿瘤学家使用“意外”问题进行筛查。
对672例患者（76%为血液系统恶性肿瘤患者）在3个月和12个月时进行了生存分析。在一年内，110例患者（16%）死亡。其中，30/52（58%）为实体肿瘤患者，但通过“意外”问题提前识别出的血液系统恶性肿瘤患者仅12/53（23%），这反映出检测敏感性不明确。很大一部分处于生命最后一年的血液学患者未被识别（77%）。生存估计与实际结果之间的匹配度一般（科恩kappa系数为0.37）。从预测到事件的时间间隔以及评估医生而非患者特征影响了该工具的准确性。
首次证明了“意外”问题在血液科门诊患者中的可行性。应进一步探索可提高血液肿瘤学家临床直觉的因素，以便及时就对临终患者重要的问题展开对话。
