• Daisy Jm Ermers, Evelien Jm Kuip, Cmm Veldhoven, Henk J Schers, Marieke Perry, Ewald M Bronkhorst, Kris Cp Vissers, and Yvonne Engels.
• Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
• Palliat Med. 2021 Mar 1; 35 (3): 592602592-602.

BackgroundThe Surprise Question ("Would I be surprised if this patient were to die within the next 12 months?") 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 ("Would I be surprised if this patient is still alive after 12 months?") if the original Surprise Question is answered with "no." The combination of the two questions is called the Double Surprise Question.AimTo examine the prognostic accuracy of the Double Surprise Question in outpatients with cancer.DesignA prospective study.ParticipantsTwelve medical oncologists completed the Double Surprise Question for 379 patients.ResultsIn 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) (p < 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.ConclusionsThe 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.

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