Prognostic significance of the "surprise" question in cancer patients.

Abstract

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. To determine the efficacy of the surprise question in patients with cancer. Prospective cohort study. Academic cancer center. 853 consecutive patients with breast, lung, or colon cancer. Surprise question classification and patient status at 12 months, alive or dead, by surprise question response. 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). Single center study. 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.