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Background: The Surprise Question ('Would I be surprised if this patient died within 12 months?') identifies patients in the last year of life. It is unclear if 'surprised' means the same for each clinician, and whether their responses are internally consistent. Aim: To determine the consistency with which the Surprise Question is used. Design: A cross-sectional online study of participants located in Belgium, Germany, Italy, The Netherlands, Switzerland and UK. Participants completed 20 hypothetical patient summaries ('vignettes'). Primary outcome measure: continuous estimate of probability of death within 12 months (0% [certain survival]–100% [certain death]). A threshold (probability estimate above which Surprise Question responses were consistently 'no') and an inconsistency range (range of probability estimates where respondents vacillated between responses) were calculated. Univariable and multivariable linear regression explored differences in consistency. Trial registration: NCT03697213. Setting/participants: Registered General Practitioners (GPs). Of the 307 GPs who started the study, 250 completed 15 or more vignettes. Results: Participants had a consistency threshold of 49.8% (SD 22.7) and inconsistency range of 17% (SD 22.4). Italy had a significantly higher threshold than other countries (p = 0.002). There was also a difference in threshold levels depending on age of clinician, for every yearly increase, participants had a higher threshold. There was no difference in inconsistency between countries (p = 0.53). Conclusions: There is variation between clinicians regarding the use of the Surprise Question. Over half of GPs were not internally consistent in their responses to the Surprise Question. Future research with standardised terms and real patients is warranted. [ABSTRACT FROM AUTHOR]

Background: For GPs to implement early palliative care, the first step is to identify patients with palliative care needs. The surprise question (SQ) is a screening tool that aims to aid this identification; for example, a response of 'no' to the SQ — 'Would you be surprised if this patient would die within a year?' — would suggest palliative care may be needed. Aim: To describe setting-specific screening results of patients eligible for early palliative care in family practices, which is defined as patients aged ≥45 years with GPs' responses of 'no' to the SQ. Design & setting: A secondary analysis was undertaken using a cross-sectional descriptive study in family practices in five areas in Belgium. Method: GPs were recruited by targeted sampling. As a first part of an implementation research project, participating GPs provided demographic information about themselves and also provided a response to the SQ for all patients who came to the practice in 10 consecutive office days. A summary table describing the sex, age, location of contact (GP surgeries, patients' homes, or nursing homes) of the patients was provided by each GP. Results: Fifty-six GPs provided complete data for the practice summary tables. In total, 9150 patients were described (all ages, all settings), of which 506 patients (6%) had a GP response of 'no' to the SQ. The distribution of SQ-no-as-answer patients per setting was: 152/7659 (2%) patients seen in family practice surgeries; 139/998 (14%) patients seen in their homes; and 215/493 (44%) patients seen in nursing homes. Conclusion: There was a large number of patients with SQ-no-as-answer, with possible palliative care needs. To enhance implementation of early palliative care, future research should compare results of SQ and other screening tools with palliative care symptoms assessments. [ABSTRACT FROM AUTHOR]

The aim of this exploratory survey was to provide an overview of physiotherapeutic and occupational therapeutic techniques and outcome measures applied in practice within palliative care. An anonymous web-based questionnaire was distributed to physiotherapists and occupational therapists in Flanders, Belgium between December 2017 and February 2018. A total of 91 respondents were included. Frequently applied interventions were: massage (51%), mobilization (49%), exercise therapy (46%), manual lymphatic drainage (42%), walking rehabilitation (40%) and breathing therapy (32%). Additional therapeutic aspects such as 'comfort care' and 'creating a therapeutic alliance' were mentioned by 34% of all therapists and cannot be ignored as an important part of treatment. Outcome measures were not always used to evaluate treatment because of time constraints and because progress was considered difficult to conceptualize in a palliative care context. The most frequently used outcome measures were a visual analogue scale (VAS) and the 6-minute walk test. In this study, the most frequently applied physiotherapeutic and occupational therapeutic interventions within palliative care were massage, mobilization and exercise therapy. However, therapists stress that these techniques are not mandatory, since care is always informed by the individual comfort and daily functioning of patients. Other than a VAS, outcome measures were used minimally. [ABSTRACT FROM AUTHOR]

Background: Starting with early identification of palliative care patients by general practitioners (GPs), the Care Pathway for Primary Palliative Care (CPPPC) is believed to help primary health care workers to deliver patient- and family-centered care in the last year of life. The care pathway has been pilot-tested, and will now be implemented in 5 Belgian regions: 2 Dutch-speaking regions, 2 French-speaking regions and the bilingual capital region of Brussels. The overall aim of the CPPPC is to provide better quality of primary palliative care, and in the end to reduce the hospital death rate. The aim of this article is to describe the quantitative design and innovative data collection strategy used in the evaluation of this complex intervention. Methods/Design: A quasi-experimental stepped wedge cluster design is set up with the 5 regions being 5 non-randomized clusters. The primary outcome is reduced hospital death rate per GPs' patient population. Secondary outcomes are increased death at home and health care consumption patterns suggesting high quality palliative care. Per research cluster, GPs will be recruited via convenience sampling. These GPs -volunteering to be involved will recruit people with reduced life expectancy and their informal care givers. Health care consumption data in the last year of life, available for all deceased people having lived in the research clusters in the study period, will be used for comparison between patient populations of participating GPs and patient populations of non-participating GPs. Description of baseline characteristics of participating GPs and patients and monitoring of the level of involvement by GPs, patients and informal care givers will happen through regular, privacy-secured web-surveys. Web-survey data and health consumption data are linked in a secure way, respecting Belgian privacy laws. Discussion: To evaluate this complex intervention, a quasi-experimental stepped wedge cluster design has been set up. Context characteristics and involvement level of participants are important parameters in evaluating complex interventions. It is possible to securely link survey data with health consumption data. By appealing to IT solutions we hope to be able to partly reduce respondent burden, a known problem in palliative care research. Trial registration: ClinicalTrials.gov Identifier: NCT02266069. [ABSTRACT FROM AUTHOR]

In recent research, Google Trends data has been identified as a potentially useful data source to complement or even replace otherwise traditional data for predicting migration flows. However, the research on this is in its infancy, and as of yet suffers from a distinctive Western bias both in the topics covered as in the applicability of the methods. To examine its wider utility, this paper evaluates the predictive potential of Google Trends data, which captures Google search frequencies, but applies it to the case of Japanese migration flows to Europe. By doing so, we focus on some of the specific challenging aspects of the Japanese language, such as its various writing systems, and of its migration flows, characterized by its relative stability and sometimes limit size. In addition, this research investigates to what extent Google Trends data can be used to empirically test theory in the form of the aspirations and (cap)ability approach. The results show that after careful consideration, this method has the potential to reach satisfactory predictions, but that there are many obstacles to overcome. As such, sufficient care and prior investigation are paramount when attempting this method for less straightforward cases, and additional studies need to address some of the key limitations more in detail to validate or annul some of the findings presented here., Supplementary Information: The online version contains supplementary material available at 10.1007/s11135-022-01560-0., Competing Interests: Conflict of interestNone of the authors have any competing interests to declare., (© The Author(s) 2022.)