The overall accuracy of the ‘Surprise Question’ in predicting a dying patient’s time of death is about 75%, which should help in appropriate referral to palliative care services.

However, a systematic review of the literature and meta-analysis found a wide range of accuracy with positive predictive values from 13.9% to 78.6%.

The review found only 26 papers investigating the utility of the question ‘Would you be surprised if this patient died within the next x months?’ in patients with illnesses including cancer, heart failure, end stage kidney disease, COPD and sepsis.

Surprisingly, the meta-analysis found no difference in the accuracy of prognostication based on specified time periods from as short as seven days to the more typical 12 months.

The study revealed doctors were more accurate than nurses, and oncologists were slightly more accurate than other medical specialists (79 v 76%).

“This review highlights that, intuitively, clinicians are actually quite good at excluding patients with longer survival times but that use of the SQ alone is likely to lead to identification of a substantial number of patients who are not necessarily approaching the ends of their lives,” the authors wrote.

“It is possible that the combination of the surprise question (SQ) with these other prognostic measures may well be more accurate than the SQ used in isolation.”

They said the findings have health resourcing implications.

“A careful balance is needed between identifying more people with unmet palliative care needs in a timely way while not over-burdening limited resources with too many patients in need of good care for long-term conditions over a much longer period.”