An online international comparison of thresholds for triggering a negative response to the "Surprise Question": a study protocol

TY - JOUR

T1 - An online international comparison of thresholds for triggering a negative response to the "Surprise Question": a study protocol

AU - White, Nicola

AU - Oostendorp, Linda

AU - Vickerstaff, Victoria

AU - Gerlach, Christina

AU - Engels, Yvonne

AU - Maessen, Maud

AU - Tomlinson, Christopher

AU - Wens, Johan

AU - Leysen, Bert

AU - Biasco, Guido

AU - Zambrano, Sofia

AU - Eychmüller, Steffen

AU - Avgerinou, Christina

AU - Chattat, Rabih

AU - Ottoboni, Giovanni

AU - Veldhoven, Carel

AU - Stone, Patrick

PY - 2019/4/9

Y1 - 2019/4/9

N2 - BACKGROUND: 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.METHODS: An online study will be completed by 600 (100 per country) 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. We will use linear regression to explore any differences in thresholds between countries and other clinician-related factors, such as years of experience. We will describe the actions taken by the clinicians and explore the differences between groups. We will also investigate the relationship between the alternative SQ and the other responses. Participants will receive a certificate of completion and the option to receive feedback on their performance.DISCUSSION: This study explores the extent to which the SQ is consistently 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.TRIAL REGISTRATION: Clinicaltrials.gov NCT03697213 (05/10/2018). Prospectively registered.

AB - BACKGROUND: 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.METHODS: An online study will be completed by 600 (100 per country) 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. We will use linear regression to explore any differences in thresholds between countries and other clinician-related factors, such as years of experience. We will describe the actions taken by the clinicians and explore the differences between groups. We will also investigate the relationship between the alternative SQ and the other responses. Participants will receive a certificate of completion and the option to receive feedback on their performance.DISCUSSION: This study explores the extent to which the SQ is consistently 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.TRIAL REGISTRATION: Clinicaltrials.gov NCT03697213 (05/10/2018). Prospectively registered.

KW - Attitude of Health Personnel

KW - Attitude to Death

KW - Belgium

KW - General Practitioners/psychology

KW - Germany

KW - Humans

KW - Internet

KW - Italy

KW - Netherlands

KW - Palliative Care/methods

KW - Prognosis

KW - Surveys and Questionnaires

KW - Switzerland

KW - United Kingdom

U2 - 10.1186/s12904-019-0413-x

DO - 10.1186/s12904-019-0413-x

M3 - SCORING: Journal article

C2 - 30979361

VL - 18

SP - 36

JO - BMC PALLIAT CARE

JF - BMC PALLIAT CARE

SN - 1472-684X

IS - 1

ER -