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Supplemental material, sj-pdf-1-pmj-10.1177_02692163211048340 for An online international comparison of palliative care identification in primary care using the Surprise Question by Nicola White, Linda JM Oostendorp, Victoria Vickerstaff, Christina Gerlach, Yvonne Engels, Maud Maessen, Christopher Tomlinson, Johan Wens, Bert Leysen, Guido Biasco, Sofia Zambrano, Steffen Eychm��ller, Christina Avgerinou, Rabih Chattat, Giovanni Ottoboni, Carel Veldhoven and Patrick Stone in Palliative Medicine

Supplemental material, sj-docx-1-pmj-10.1177_02692163211048340 for An online international comparison of palliative care identification in primary care using the Surprise Question by Nicola White, Linda JM Oostendorp, Victoria Vickerstaff, Christina Gerlach, Yvonne Engels, Maud Maessen, Christopher Tomlinson, Johan Wens, Bert Leysen, Guido Biasco, Sofia Zambrano, Steffen Eychm��ller, Christina Avgerinou, Rabih Chattat, Giovanni Ottoboni, Carel Veldhoven and Patrick Stone in Palliative Medicine

Template for vignettes. (PDF 604 kb)

SPIRIT checklist. (PDF 172 kb)

Background: To help general practitioners (GPs) in early identification of patients with palliative care (PC) needs, this pilot study aimed to determine the potential of the combined original surprise question (SQ1) (%Would I be surprised if this patient died within the next 12 months?%) and the second surprise question (SQ2) (%Would I be surprised if this patient was still alive after 12 months?%). We hypothesized that answering these SQs would trigger them to make a multidimensional care plan. Methods: 26 Slovenian GPs, randomized into 4 groups, were invited to write a care plan for each of the four patients described in case vignettes (2 oncologic, 1 organ failure and 1 frailty case). GPs in group 1 were only asked to write a care plan for each patient. GPs in group 2 answered SQ1 and GPs in groups 3 and 4 answered SQ1 and SQ2 before writing the care plan. The type and number of PC aspects mentioned in the respective care plans were quantified into a numeric RADboud ANTicipatory (RADIANT) score. Results: Mean RADIANT scores in groups 1-4 were 2.2, 3.6, 2.5 and 3.1, respectively. When comparing the different vignettes, vignette B (terminal oncologic patient) scored best (3.6). Mean RADIANT scores in groups 3 and 4 were slightly higher for GPs who would be surprised compared to GPs who would not be surprised if the patient was still alive in 12 months. Conclusion: The combined SQs were considered helpful in the early identification of patients in need of PC in Slovenian general practice

Pain is one of the main factors influencing quality of life; its incidence is higher than is generally assumed. Pain is not spontaneously reported in all cases; it should be asked about more often. Not measuring pain is one of the main reasons for inadequate pain treatment. Pain should be assessed and recorded more routinely in both primary and secondary healthcare. This can be done in simple and quick ways. Self-reporting using a visual-analogue scale or numeric rating scale is the preferred method. This can be done even by patients with a mild cognitive disorder. Several simple and reliable observational scales exist for patients who cannot report well, e.g. elderly patients with a cognitive disorder or young children. For chronic pain, the low-threshold use of a multi-dimensional scale will increase the likelihood of successful treatment.

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. Electronic supplementary material The online version of this article (10.1186/s12904-019-0413-x) contains supplementary material, which is available to authorized users.