Researchers Predict End of Life with “Surprise” Question

Disclaimer: Results are not guaranteed*** and may vary from person to person***.

End of LifeAccording to the American Cancer Society, there will be an estimated 589,430 deaths from cancer in the U.S. in 2015.

A research team has discovered that a simple question may be an effective way to help clinicians predict which cancer patients are nearing death: “Would you be surprised if this patient died within the next year?”

When considering the answer to the question, clinicians would predict which of their patients had a higher risk of death within a year of the study. The new study was presented this month at the 2015 Palliative Care in Oncology Symposium (PCOS).

In the study, researchers found that the clinicians had responded with “Yes, I would be surprised” in 83% of their patients, and “No, I would not be surprised,” in 17% of their end-of-life cancer patients. A negative response was established in 60% of patients who died within a 12-month period. Also, the “surprise” question failed to detect around 40% of patients who passed away within the year.

“Our results showed that oncology clinicians’ own judgment using the ‘surprise’ question identified about 60% of decreased patients,” commented study author Judith B. Vick, who is also a medical student at Johns Hopkins University School of Medicine, Baltimore, Maryland. “Given that 40% of decreased patients were not identified by the ‘surprise’ question, more research is needed to understand factors that contribute to non-recognition of so many patients.”

For the study, there were 81 oncology clinicians enrolled in the cohort trial between July 2012 and October 2014. The oncology clinicians included physician assistants, nurse practitioners, and oncologists at the Dana-Farber Cancer Institute.

There were 76 clinicians that presented the “surprise” question to 4,779 cancer patients that were in all stages of the condition. The patients had been diagnosed with various types of cancer, including thoracic, head and neck, breast, genitourinary, and gastrointestinal cancer, and also lymphoma and sarcoma.

The study authors suggest that the “surprise” question was a better predictor of patient death than cancer stage, time since diagnosis, age, and type of cancer. The “surprise” question tool was developed in the 1990s; however, there has been limited evidence of its use in a cancer care setting.

American Society of Clinical Oncology expert Dr. Don S. Dizon also commented on the study findings: “This important work shows that one question that clinicians actually ask themselves may be more effective than the usual clinical and laboratory parameters to identify patients that have a high risk of dying within a year. I think this is important, especially in an era where we are looking at values and preferences regarding current and future cancer care, and I look forward to future results of this multipronged intervention.”

The findings from Vick and her team are part of an ongoing randomized study from a patient-centered serious-illness care program, which had been created by a Boston laboratory, Ariadne Labs, and is being studied at Dana-Farber Cancer Institute. The “surprise” question is the first step of the comprehensive patient-centered Serious Illness Care Program from Ariadne Labs.

Sources for Today’s Article:
“The utility of the surprise question in identifying patients most at risk of death,” Palliative Care in Oncology Symposium (PCOS) 2015, Abstract 8;
Nelson, R., “’Surprise’ Question Effective at Predicting End of Life,” Medscape Multispecialty web site, October 8, 2015;
“Cancer Facts & Figures 2015,” American Cancer Society web site;, last accessed October 9, 2015.