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

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.

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