How Well Does the Surprise Question Predict 1-year Mortality for Patients Admitted with COPD?
© 2021. Society of General Internal Medicine..
BACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) often receive burdensome care at end-of-life (EOL) and infrequently complete advance care planning (ACP). The surprise question (SQ) is a prognostic tool that may facilitate ACP.
OBJECTIVE: To assess how well the SQ predicts mortality and prompts ACP for COPD patients.
DESIGN: Retrospective cohort study.
SUBJECTS: Patients admitted to the hospital for an acute exacerbation of COPD between July 2015 and September 2018.
MAIN MEASURES: Emergency department (ED) and inpatient clinicians answered, "Would you be surprised if this patient died in the next 30 days (ED)/one year (inpatient)?" The primary outcome measure was the accuracy of the SQ in predicting 30-day and 1-year mortality. The secondary outcome was the correlation between SQ and ACP (palliative care consultation, documented goals-of-care conversation, change in code status, or completion of ACP document).
KEY RESULTS: The 30-day SQ had a high specificity but low sensitivity for predicting 30-day mortality: sensitivity 12%, specificity 95%, PPV 11%, and NPV 96%. The 1-year SQ demonstrated better accuracy for predicting 1-year mortality: sensitivity 47%, specificity 75%, PPV 35%, and NPV 83%. After multivariable adjustment for age, sex, and prior 6-month admissions, 1-year SQ+ responses were associated with greater odds of 1-year mortality (OR 2.38, 95% CI 1.39-4.08) versus SQ-. One-year SQ+ patients were more likely to have a goals-of-care conversation (25% vs. 11%, p < 0.01) and complete an advance directive or POLST (46% vs. 23%, p < 0.01). After multivariable adjustment, SQ+ responses to the 1-year SQ were associated with greater odds of ACP receipt (OR 2.67, 95% CI 1.64-4.36).
CONCLUSIONS: The 1-year surprise question may be an effective component of prognostication and advance care planning for COPD patients in the inpatient setting.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:36 |
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| Enthalten in: |
Journal of general internal medicine - 36(2021), 9 vom: 06. Sept., Seite 2656-2662 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Tripp, Dana [VerfasserIn] |
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| Links: |
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| Themen: |
Advance care planning |
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| Anmerkungen: |
Date Completed 21.10.2021 Date Revised 02.09.2022 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1007/s11606-020-06512-8 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2021. Society of General Internal Medicine. | ||
| 520 | |a BACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) often receive burdensome care at end-of-life (EOL) and infrequently complete advance care planning (ACP). The surprise question (SQ) is a prognostic tool that may facilitate ACP | ||
| 520 | |a OBJECTIVE: To assess how well the SQ predicts mortality and prompts ACP for COPD patients | ||
| 520 | |a DESIGN: Retrospective cohort study | ||
| 520 | |a SUBJECTS: Patients admitted to the hospital for an acute exacerbation of COPD between July 2015 and September 2018 | ||
| 520 | |a MAIN MEASURES: Emergency department (ED) and inpatient clinicians answered, "Would you be surprised if this patient died in the next 30 days (ED)/one year (inpatient)?" The primary outcome measure was the accuracy of the SQ in predicting 30-day and 1-year mortality. The secondary outcome was the correlation between SQ and ACP (palliative care consultation, documented goals-of-care conversation, change in code status, or completion of ACP document) | ||
| 520 | |a KEY RESULTS: The 30-day SQ had a high specificity but low sensitivity for predicting 30-day mortality: sensitivity 12%, specificity 95%, PPV 11%, and NPV 96%. The 1-year SQ demonstrated better accuracy for predicting 1-year mortality: sensitivity 47%, specificity 75%, PPV 35%, and NPV 83%. After multivariable adjustment for age, sex, and prior 6-month admissions, 1-year SQ+ responses were associated with greater odds of 1-year mortality (OR 2.38, 95% CI 1.39-4.08) versus SQ-. One-year SQ+ patients were more likely to have a goals-of-care conversation (25% vs. 11%, p < 0.01) and complete an advance directive or POLST (46% vs. 23%, p < 0.01). After multivariable adjustment, SQ+ responses to the 1-year SQ were associated with greater odds of ACP receipt (OR 2.67, 95% CI 1.64-4.36) | ||
| 520 | |a CONCLUSIONS: The 1-year surprise question may be an effective component of prognostication and advance care planning for COPD patients in the inpatient setting | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a advance care planning | |
| 650 | 4 | |a chronic obstructive pulmonary disease | |
| 650 | 4 | |a goals-of-care | |
| 650 | 4 | |a prognostication | |
| 650 | 4 | |a surprise question | |
| 700 | 1 | |a Janis, Jaclyn |e verfasserin |4 aut | |
| 700 | 1 | |a Jarrett, Benjamin |e verfasserin |4 aut | |
| 700 | 1 | |a Lucas, F Lee |e verfasserin |4 aut | |
| 700 | 1 | |a Strout, Tania D |e verfasserin |4 aut | |
| 700 | 1 | |a Han, Paul K J |e verfasserin |4 aut | |
| 700 | 1 | |a Stumpf, Isabella |e verfasserin |4 aut | |
| 700 | 1 | |a Hutchinson, Rebecca N |e verfasserin |4 aut | |
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