Evidence map›Paper›PMID 34596445›Full record

ArticlePalliative medicine2022

An online international comparison of palliative care identification in primary care using the Surprise Question.

Nicola White, Linda Jm Oostendorp, Victoria Vickerstaff, Christina Gerlach, Yvonne Engels, Maud Maessen, Christopher Tomlinson, Johan Wens, Bert Leysen, Guido Biasco and 7 more

Registry-linked trialOpen access · hybridAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Palliative medicine, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03697213 (An Online International Comparison of Thresholds for Triggering a Negative Response to the "Surprise Question"), which is not on this map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
0.6field-weighted citation impact, top 29% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03697213 completednot on this map

An Online International Comparison of Thresholds for Triggering a Negative Response to the "Surprise Question"

TypeobservationalSponsorUniversity College, LondonRan2019 to 2020Enrolled250ConditionsPalliative Care, Terminal IllnessArmsOnline study
3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 8 citations in OpenAlex.

  1. Trial
  2. Article
  3. When would I be surprised? Variability in predicted probability of survival for being "surprised" and "not surprised" to the surprise question.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2025
    Article
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

17 authors at 7 institutions in 6 countries.

Nicola WhiteMarie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK.ORCID 0000-0002-7438-0072
Linda Jm OostendorpMarie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK.
Victoria VickerstaffMarie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK.
Christina GerlachPalliative Care Unit, Department of Oncology, Hematology and BMT, and Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.ORCID 0000-0003-2182-9427
Yvonne EngelsAnesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands.ORCID 0000-0002-7669-1018
Maud MaessenUniversity Center for Palliative Care, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland.
Christopher TomlinsonDepartment of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK.
Johan WensDepartment Family Medicine and Population Health (FamPop), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
Bert LeysenDepartment of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK.ORCID 0000-0001-7051-7601
Guido BiascoDepartment of Experimental, Diagnostic and Specialty Medicine, University of Bologna & Academy of the Sciences of Palliative Medicine, Bologna, Italy.
Sofia ZambranoUniversity Center for Palliative Care, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland.
Steffen EychmüllerUniversity Center for Palliative Care, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland.ORCID 0000-0003-1734-2237
Christina AvgerinouPrimary Care and Population Health, Institute of Epidemiology and Health Care, University College London, London, UK.
Rabih ChattatDepartment of Psychology, University of Bologna, Bologna, Italy.
Giovanni OttoboniDepartment of Psychology, University of Bologna, Bologna, Italy.
Carel VeldhovenAnesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands.
Patrick StoneMarie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK.
University College London · GBUniversity of Bern · CHUniversity of Bologna · ITImperial College London · GBRadboud University Nijmegen · NLUniversität Hamburg · DEUniversity of Antwerp · BE

Funding

Marie Curie MCCC-FCH-18-UMarie Curie MCCC-FCO-11-U
6 · The paper itself

Abstract

backgroundThe Surprise Question ('Would I be surprised if this patient died within 12 months?') identifies patients in the last year of life. It is unclear if 'surprised' means the same for each clinician, and whether their responses are internally consistent.

aimTo determine the consistency with which the Surprise Question is used.

designA cross-sectional online study of participants located in Belgium, Germany, Italy, The Netherlands, Switzerland and UK. Participants completed 20 hypothetical patient summaries ('vignettes'). Primary outcome measure: continuous estimate of probability of death within 12 months (0% [certain survival]-100% [certain death]). A threshold (probability estimate above which Surprise Question responses were consistently 'no') and an inconsistency range (range of probability estimates where respondents vacillated between responses) were calculated. Univariable and multivariable linear regression explored differences in consistency. Trial registration: NCT03697213. SETTING/

participantsRegistered General Practitioners (GPs). Of the 307 GPs who started the study, 250 completed 15 or more vignettes.

resultsParticipants had a consistency threshold of 49.8% (SD 22.7) and inconsistency range of 17% (SD 22.4). Italy had a significantly higher threshold than other countries (

conclusionsThere is variation between clinicians regarding the use of the Surprise Question. Over half of GPs were not internally consistent in their responses to the Surprise Question. Future research with standardised terms and real patients is warranted.

Indexed as

Hospice and Palliative Care NursingPalliative CareCross-Sectional StudiesHumansPrimary Health CarePrognosispalliative careprimary health carePrognosissurvival

Identifiers

PMID34596445
PMCPMC8796152
OpenAlexW3203215198

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.