The Surprise study

The Surprise Question (SQ) "would I be surprised if this patient were to die in the next 12 months?" has been suggested to help clinicians, and especially General Practitioners (GPs), identify people who might benefit from palliative care. The prognostic accuracy of this approach is unclear and little is known about how GPs use this tool in practice. Are GPs consistent, individually and as a group? Are there international differences in the use of the tool? Does including the alternative Surprise Question ("Would I be surprised if the patient were still alive after 12 months?") alter the response? What is the impact on the treatment plan in response to the SQ? This study aims to address these questions.

The Surprise Study is the first study of a collaboration of six countries (UK, Belgium, Germany, The Netherlands, Switzerland, and Italy). This collaboration was formed as a result of our previously reported systematic review on the accuracy of the Surprise Question

It is an online study which will be completed by registered GPs. They will be asked to review 20 hypothetical patient vignettes. For each vignette they will be asked to provide a response to the following four questions: (1) the SQ [Yes/No]; (2) the alternative SQ [Yes/No]; (3) the percentage probability of dying [0% no chance - 100% certain death]; and (4) the proposed treatment plan [multiple choice]. A "surprise threshold" for each participant will be calculated by comparing the responses to the SQ with the probability estimates of death.

This study explores the extent to which the SQ is used at an individual, group, and national level. The findings of this study will help to understand the clinical value of using the SQ in routine practice.

This study is currently recruiting. If you are a registered General Practitioner who works within the UK, please do get in touch with the study lead: Dr Nicola White (n.g.white@ucl.ac.uk).

(clinicaltrials.gov identifier: NCT03697213)