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Early palliative care: the surprise question and the palliative care screening tool—better together
  1. Yung-Feng Yen1,2,3,
  2. Ya-Ling Lee4,5,
  3. Hsiao-Yun Hu2,6,
  4. Wen-Jung Sun7,
  5. Ming-Chung Ko3,8,
  6. Chu-Chieh Chen3,
  7. Weng Kee Wong9,
  8. Donald E Morisky10,
  9. Sheng-Jean Huang11,12 and
  10. Dachen Chu2,11
  1. 1Section of Infectious Diseases, Taipei City Hospital Yangming Branch, Taipei, Taiwan
  2. 2Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
  3. 3Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
  4. 4Department of Dentistry, Taipei City Hospital, Taipei, Taiwan
  5. 5Department of Dentistry, School of Dentistry, National Yang-Ming University, Taipei, Taiwan
  6. 6Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
  7. 7Community Medicine Department & Family Medicine Division, Taipei City Hospital Zhongxing Branch, Taipei, Taiwan
  8. 8Department of Urology, Taipei City Hospital, Taipei, Taiwan
  9. 9Department of Biostatistics, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA
  10. 10Department of Community Health Sciences, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA
  11. 11Department of Neurosurgery, Taipei City Hospital, Taipei, Taiwan
  12. 12Department of Surgery, Medical College, National Taiwan University Hospital, Taipei, Taiwan
  1. Correspondence to Dr Yung-Feng Yen, Section of Infectious Diseases, Taipei City Hospital Yangming Branch, Taipei City 10341, Taiwan; yfyen1{at}gmail.com

Abstract

Objective The ‘surprise question’ (SQ) and the palliative care screening tool (PCST) are the common assessment tools in the early identification of patients requiring palliative care. However, the comparison of their prognostic accuracies has not been extensively studied. This study aimed to compare the prognostic accuracy of SQ and PCST in terms of recognising patients nearing end of life (EOL) and those appropriate for palliative care.

Methods This prospective study used both the SQ and PCST to predict patients’ 12-month mortality and identified those appropriate for palliative care. All adult patients admitted to Taipei City Hospital in 2015 were included in this cohort study. The c-statistic value was calculated to indicate the predictive accuracies of the SQ and PCST.

Results Out of 21 109 patients, with a mean age of 62.8 years, 12.4% and 11.1% had a SQ response of ‘no’ and a PCST score of ≥4, respectively. After controlling for other covariates, an SQ response of ‘no’ and a PCST score of ≥4 were the independent predictors of 12-month mortality. The c-statistic values of the SQ and PCST at recognising patients in their last year of life were 0.680 and 0.689, respectively. When using a combination of both SQ and PCST in predicting patients’ 12-month mortality risk, the predictive value of the c-statistic increased to 0.739 and was significantly higher than either one in isolation (p<0.001).

Conclusion A combination of the SQ with PCST has better prognostic accuracy than either one in isolation.

  • hospice care
  • supportive care

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Footnotes

  • Y-FY, Y-LL and H-YH contributed equally.

  • Contributors All authors substantially contributed to the conception and design of the study, data analysis, data interpretation and the drafting of the manuscript. Y-FY, Y-LL, H-YH, W-JS, M-CK, C-CC, W-KW, S-JH and DC substantially contributed to data acquisition and interpretation of the results. All authors approved the final version of the manuscript.

  • Funding This study was supported by a grant from the Department of Health, Taipei City Government, Taiwan. The study sponsor was not involved in the study design, the collection, analysis, or interpretation of the data, the writing of this report, or the decision to submit it for publication.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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