我何时会感到惊讶？对于“惊讶”问题，“感到惊讶”和“不感到惊讶”的预测生存概率的变异性。
When would I be surprised? Variability in predicted probability of survival for being "surprised" and "not surprised" to the surprise question.
作者信息
Hui David, Ontai Amy, Andersen Clark, Maxwell John P, Hiratsuka Yusuke, Suh Sang-Yeon, Kim Sun Hyun, Bruera Eduardo
机构信息
Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Unit 1414, 1515 Holcombe Boulevard, Houston, TX, 77030, USA.
Department of General Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
出版信息
Support Care Cancer. 2025 Jul 25;33(8):720. doi: 10.1007/s00520-025-09761-7.
PURPOSE
The surprise question is commonly used in clinical practice; however, the variability in how "surprise" is defined is unclear. We examined the variability in the predicted probability of survival for being "surprised" and "not surprised" among palliative care physicians across seven timeframes.
METHODS
Palliative care specialists completed the surprise question for 3 days, 1 week, 2 weeks, 1 month, 2 months, 3 months, and 6 months for patients with advanced cancer at an outpatient clinic and concurrently predicted the probability of survival (0-100%). The primary outcome, coefficient of variation (CV) for the predicted probability of survival, was computed for "surprised" and "not surprised" answers for each physician and each timeframe. A mixed-effect logistic regression assessed the probability threshold for being "surprised."
RESULTS
Twenty physicians provided 3024 survival estimates for 216 patients (mean age 61, 50% female). When "surprised," physicians consistently predicted a probability of survival > 50%, with low variation among physicians (mean CV 6-23%) and across timeframes (mean CV 5-20%). In contrast, physicians who answered "not surprised" predicted a probability of survival from 2 to 100%, with high variation among physicians (mean CV 15-83%) and across timeframes (mean CV 22-69%). Variability increased with longer timeframes. The probability of survival thresholds for being "surprised" were ≥ 74%, ≥ 62%, ≥ 68%, ≥ 83%, and ≥ 84% for 1 week, 2 weeks, 1 month, 2 months, and 3 months, respectively.
CONCLUSION
We found low variability for predicted probability of survival when clinicians were "surprised" but high variability when they were "not surprised."
目的
意外问题在临床实践中常用；然而，“意外”的定义存在何种差异尚不清楚。我们研究了七个时间框架内姑息治疗医生对“意外”和“不意外”患者生存预测概率的差异。
方法
姑息治疗专家针对门诊晚期癌症患者，在3天、1周、2周、1个月、2个月、3个月和6个月时完成意外问题，并同时预测生存概率（0 - 100%）。主要结局指标为每位医生和每个时间框架内“意外”和“不意外”回答的生存预测概率变异系数（CV）。采用混合效应逻辑回归评估“意外”的概率阈值。
结果
20名医生为216名患者（平均年龄61岁，50%为女性）提供了3024次生存估计。当回答“意外”时，医生一致预测生存概率>50%，医生之间（平均CV 6 - 23%）以及不同时间框架之间（平均CV 5 - 20%）差异较小。相比之下，回答“不意外”的医生预测生存概率为2%至100%，医生之间（平均CV 15 - 83%）以及不同时间框架之间（平均CV 22 - 69%）差异较大。随着时间框架延长，差异增大。对于1周、2周、1个月、2个月和3个月时“意外”的生存概率阈值分别为≥74%、≥62%、≥68%、≥83%和≥84%。
结论
我们发现临床医生回答“意外”时生存预测概率差异较小，而回答“不意外”时差异较大。
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