scholarly journals Screening with the double surprise question to predict deterioration and death: an explorative study

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
C. M. M. Veldhoven ◽  
N. Nutma ◽  
W. De Graaf ◽  
H. Schers ◽  
C. A. H. H. V. M. Verhagen ◽  
...  
Keyword(s):  
Palliative Care ◽  
General Practice ◽  
Primary Outcome ◽  
Care Needs ◽  
Explorative Study ◽  
Surprise Question ◽  
Record Review ◽  
Palliative Care Needs ◽  
Palliative Patients ◽  
Retrospective Medical Record Review

Abstract Background Early identification of palliative patients is challenging. The Surprise Question (SQ1; Would I be surprised if this patient were to die within 12 months?) is widely used to identify palliative patients. However, its predictive value is low. Therefore, we added a second question (SQ2) to SQ1: ‘Would I be surprised if this patient is still alive after 12 months?’ We studied the accuracy of this double surprise question (DSQ) in a general practice. Methods We performed a prospective cohort study with retrospective medical record review in a general practice in the eastern part of the Netherlands. Two general practitioners (GPs) answered both questions for all 292 patients aged ≥75 years (mean age 84 years). Primary outcome was 1-year death, secondary outcomes were aspects of palliative care. Results SQ1 was answered with ‘no‘ for 161/292 patients. Of these, SQ2 was answered with ‘yes’ in 22 patients. Within 12 months 26 patients died, of whom 24 had been identified with SQ1 (sensitivity: 92%, specificity: 49%). Ten of them were also identified with SQ2 (sensitivity: 42%, specificity: 91%). The latter group had more contacts with their GP and more palliative care aspects were discussed. Conclusions The DSQ appears a feasible and easy applicable screening tool in general practice. It is highly effective in predicting patients in high need for palliative care and using it helps to discriminate between patients with different life expectancies and palliative care needs. Further research is necessary to confirm the findings of this study.

scholarly journals A New Approach to the Identification of Palliative Care Needs and Advanced Chronic Patients among Nursing Home Residents

2021 ◽  
Vol 18 (6) ◽  
pp. 3171
Author(s):  
Ana A. Esteban-Burgos ◽  
María José Lozano-Terrón ◽  
Daniel Puente-Fernandez ◽  
César Hueso-Montoro ◽  
Rafael Montoya-Juárez ◽  
...  
Keyword(s):  
Palliative Care ◽  
Nursing Homes ◽  
Statistical Significance ◽  
Nursing Home Residents ◽  
Cross Sectional Study ◽  
Care Needs ◽  
Chronic Patients ◽  
Cross Sectional ◽  
Surprise Question ◽  
Palliative Care Needs

Background: Proper planning of Palliative Care in nursing homes requires advanced knowledge of the care needs that residents show. The aim of the study was to evaluate Palliative Needs and other conditions such as fragility, complexity, and prognosis and also to suggest new indicators for the establishment of the resident’s advanced chronic condition. Methods: Cross-sectional study conducted in 149 nursing homes Complex Chronic residents evaluated by trained professionals. Palliative Care Needs, assessed by the NECPAL ICO-CCOMS© tool, and fragility, case and palliative complexity and prognosis were evaluate through a comprehensive assessment. Descriptive analyses and association measures were performed setting the statistical significance at 0.05. Results: More than 50% of the residents had positive Surprise Question and other Palliative Needs and were classified as Advanced Chronic Patients. Distress and/or Severe Adaptative Disorder was the most frequent need shown by the residents and significant differences in levels of frailty and other characteristics, were found between the Positive and the Negative Surprise Question Groups. Statistically significant correlations were also found between aspects of both groups. Conclusions: Nursing homes residents show Palliative Needs regardless of the response to the Surprise Question of the NECPAL tool. Other characteristics such as presence of an intermediate level of frailty are suggested as a new perspective to identify advanced chronic patients among nursing homes residents.

Neuropalliative rehabilitationManaging neurological disability in the context of a deteriorating illness

2020 ◽  
pp. 401-411
Author(s):  
Gail Eva ◽  
Jo Bayly ◽  
E. Diane Playford
Keyword(s):  
Palliative Care ◽  
Rehabilitation Services ◽  
Active Engagement ◽  
Coordination Of Care ◽  
Care Needs ◽  
Neurological Disability ◽  
Neurological Conditions ◽  
Rehabilitation Needs ◽  
Palliative Care Needs ◽  
Palliative Patients

Although the concepts of ‘rehabilitation’ and ‘palliative care’ may seem paradoxical, the two approaches have a great deal in common. Rehabilitation for people with deteriorating, life-limiting neurological conditions can be organized into four distinct but overlapping categories: preventative, restorative, supportive, and palliative. Patients with neurological conditions can report palliative care needs from diagnosis; neuropalliative rehabilitation needs to be available within the context of whatever services are most appropriate for the patient’s circumstances at the time, requiring excellent coordination of care between neurology, palliative care, and rehabilitation services. Neuropalliative rehabilitation follows the same process that would be used in other conditions, but is underpinned by specific palliative care skills which include the ability to work flexibly with rapidly changing conditions, as well as understanding and being able to manage the tension between the patient’s active engagement in life and acknowledging loss and death.

Using the Surprise Question To Identify Those with Unmet Palliative Care Needs in Emergency and Inpatient Settings: What Do Clinicians Think?

2017 ◽  
Vol 20 (7) ◽  
pp. 729-735 ◽  
Author(s):  
Samir A. Haydar ◽  
Lisa Almeder ◽  
Lauren Michalakes ◽  
Paul K.J. Han ◽  
Tania D. Strout
Keyword(s):  
Palliative Care ◽  
Care Needs ◽  
Inpatient Settings ◽  
Surprise Question ◽  
Palliative Care Needs

scholarly journals Early identification of palliative care patients in general practice: development of RADboud indicators for PAlliative Care Needs (RADPAC)

2012 ◽  
Vol 62 (602) ◽  
pp. e625-e631 ◽  
Author(s):  
Bregje Thoonsen ◽  
Yvonne Engels ◽  
Eric van Rijswijk ◽  
Stans Verhagen ◽  
Chris van Weel ◽  
...  
Keyword(s):  
Palliative Care ◽  
General Practice ◽  
Early Identification ◽  
Care Needs ◽  
Practice Development ◽  
Palliative Care Needs

scholarly journals The Surprise Question and Identification of Palliative Care Needs among Hospitalized Patients with Advanced Hematologic or Solid Malignancies

2018 ◽  
Vol 21 (6) ◽  
pp. 789-795 ◽  
Author(s):  
Kathryn Elizabeth Hudson ◽  
Steven Paul Wolf ◽  
Gregory P. Samsa ◽  
Arif H. Kamal ◽  
Amy Pickar Abernethy ◽  
...  
Keyword(s):  
Palliative Care ◽  
Hospitalized Patients ◽  
Care Needs ◽  
Solid Malignancies ◽  
Surprise Question ◽  
Palliative Care Needs

scholarly journals What makes palliative care needs “complex”? A multisite sequential explanatory mixed methods study of patients referred for specialist palliative care

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Anne M. Finucane ◽  
Connie Swenson ◽  
John I. MacArtney ◽  
Rachel Perry ◽  
Hazel Lamberton ◽  
...  
Keyword(s):  
Palliative Care ◽  
Focus Groups ◽  
Healthcare Professionals ◽  
Psychological Needs ◽  
Care Providers ◽  
Specialist Palliative Care ◽  
Care Needs ◽  
Complex Needs ◽  
Sequential Explanatory ◽  
Palliative Care Needs

Abstract Background Specialist palliative care (SPC) providers tend to use the term ‘complex’ to refer to the needs of patients who require SPC. However, little is known about complex needs on first referral to a SPC service. We examined which needs are present and sought the perspectives of healthcare professionals on the complexity of need on referral to a hospice service. Methods Multi-site sequential explanatory mixed method study consisting of a case-note review and focus groups with healthcare professionals in four UK hospices. Results Documentation relating to 239 new patient referrals to hospice was reviewed; and focus groups involving 22 healthcare professionals conducted. Most patients had two or more needs documented on referral (96%); and needs were recorded across two or more domains for 62%. Physical needs were recorded for 91% of patients; psychological needs were recorded for 59%. Spiritual needs were rarely documented. Referral forms were considered limited for capturing complex needs. Referrals were perceived to be influenced by the experience and confidence of the referrer and the local resource available to meet palliative care needs directly. Conclusions Complexity was hard to detail or to objectively define on referral documentation alone. It appeared to be a term used to describe patients whom primary or secondary care providers felt needed SPC knowledge or support to meet their needs. Hospices need to provide greater clarity regarding who should be referred, when and for what purpose. Education and training in palliative care for primary care nurses and doctors and hospital clinicians could reduce the need for referral and help ensure that hospices are available to those most in need of SPC input.

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