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Background: For general practitioners (GPs) to implement early palliative care, the first step is to identify patients with palliative care needs, e.g. with a no-response to the Surprise Question (SQ) (not surprised if a patient would die within a year). Aim: To describe setting-specific screening results of patients eligible for early palliative care in family practices, here defined as patients aged 45 years with a GPs’ no-answer to the SQ. Design and setting: Secondary analysis. Cross-sectional descriptive study in family practices in 5 Belgian areas. Methods: 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 ten consecutive office days. A summary table describing the gender, age, location of contact (surgery, patient’s home, or nursing home) of the patients was provided by each GP. Results: 56 GPs provided complete data for the practice summary tables. In total 9,150 patients were described (all ages, all settings), of which 506 patients (6%) had a SQ-no-as-answer. 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 innursing homes. Conclusions: There was quite a large number of SQ-no-as-answer patients, 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.

Template for vignettes. (PDF 604 kb)

Als huisarts in het Belgische dorpje Broechem, onderzoeker palliatieve zorg aan de Universiteit Antwerpen en stichtend bestuurslid van de eerstelijnszone Pallieterland begeef ik mij constant in het dynamische veld tussen engagement en reflectie.

SPIRIT checklist. (PDF 172 kb)

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.