The 'surprise' question in paediatric palliative care: A prospective cohort study.
Palliat Med
; 32(2): 535-542, 2018 02.
Article
en En
| MEDLINE
| ID: mdl-28627303
ABSTRACT
BACKGROUND:
The question 'would you be surprised if this patient died in the next 12-months' is widely used for identifying adult patients in the last year of life. However, this has not yet been studied in children.AIM:
To assess the prognostic accuracy of the surprise question when used by a multidisciplinary team to predict survival outcomes of children with life-limiting conditions over a 3 and 12 month period.DESIGN:
A prospective cohort study. SETTING/PARTICIPANTS:
Six multidisciplinary team members working in a children's hospice answered a 3 and 12 month surprise question about 327 children who were either newly referred or receiving care at the hospice between 2011 and 2013.RESULTS:
The prognostic accuracy of the multidisciplinary team for the 3 (and 12)month surprise question were sensitivity 83.3% (83.3%), specificity 93.2% (70.7%), positive predictive value 41.7% (23.6%), negative predictive value 99% (97.5%) and accuracy 92.6% (71.9%). Patients with a 'no' response had an increased risk of death at 3 (hazard ratio, 22.94, p ⩽ 0.001) and 12 months (hazard ratio, 6.53, p ⩽ 0.001).CONCLUSION:
The surprise question is a highly sensitive prognostic tool for identifying children receiving palliative care who are in the last 3 and 12 months of life. The tool is accurate at recognising children during stable periods demonstrated through a high negative predictive value. In practice, this tool could help identify children who would benefit from specialist end of life care, act as a marker to facilitate communications on advance care planning and assist in resource allocation.Palabras clave
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Cuidados Paliativos
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Pronóstico
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Sobrevida
/
Personal de Salud
Tipo de estudio:
Etiology_studies
/
Observational_studies
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Prognostic_studies
/
Risk_factors_studies
Límite:
Adolescent
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Child
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Child, preschool
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Female
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Humans
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Infant
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Male
Idioma:
En
Revista:
Palliat Med
Asunto de la revista:
SERVICOS DE SAUDE
Año:
2018
Tipo del documento:
Article
País de afiliación:
Reino Unido