Prognostic significance of the "surprise" question in cancer patients

J Palliat Med. 2010 Jul;13(7):837-40. doi: 10.1089/jpm.2010.0018.


Background: Physicians consistently overestimate survival for patients with cancer. The "surprise" question--"Would I be surprised if this patient died in the next year?"--improves end-of-life care by identifying patients with a poor prognosis. It has not been previously studied in patients with cancer.

Objective: To determine the efficacy of the surprise question in patients with cancer.

Design: Prospective cohort study.

Setting: Academic cancer center.

Patients: 853 consecutive patients with breast, lung, or colon cancer.

Measurements: Surprise question classification and patient status at 12 months, alive or dead, by surprise question response.

Results: Oncologists classified 826 of 853 prospective patients with cancer (97%) with 131 (16%) classified into the "No" group and 695 (84%) into the "Yes" group. In multivariate analysis, a "No" response identified patients with cancer who had a seven times greater hazard of death in the next year compared to patients in the "Yes" group (HR 7.787, p < 0.001).

Limitations: Single center study.

Conclusion: The surprise question is a simple, feasible, and effective tool to identify patients with cancer who have a greatly increased risk of 1-year mortality.

MeSH terms

  • Advance Directives
  • Aged
  • Attitude of Health Personnel*
  • Cohort Studies
  • Female
  • Humans
  • Judgment
  • Male
  • Medical Futility
  • Medical Oncology / methods*
  • Medical Oncology / standards
  • Middle Aged
  • Neoplasms / diagnosis*
  • Neoplasms / therapy
  • Palliative Care / methods*
  • Palliative Care / standards
  • Prognosis
  • Proportional Hazards Models
  • Prospective Studies
  • Risk Assessment
  • Severity of Illness Index
  • Terminal Care / methods*
  • Terminal Care / standards
  • West Virginia