The Surprise Study

An Online International Comparison of Thresholds for Triggering a Negative Response to the "Surprise Question"

This study investigates the use of the Surprise Question [SQ] (would you be surprised if this patient were to die in the next 12 months?) in routine practice. In particular, the study will investigate the consistency of the responses to the SQ and the relationship with the subsequent course of action decided upon.

Study Overview

• Status: Completed
• Conditions: Palliative Care; Terminal Illness
• Intervention / Treatment: Other: Online study

Detailed Description

Whilst the original use of the Surprise Question was to identify people who might be in the last year of life and benefit from palliative care, the prognostic capability of the Surprise Question has been shown to be variable. What is unclear, is the extent to which a doctor should be "surprised" before a patient is suitable for palliative care, how consistently doctors respond to this question, and how the subsequent treatment decision relates to the SQ response.

The study will recruit 600 General Practitioners (GPs) from 6 participating countries (100 per country; UK, Germany, Switzerland, Italy, Belgium, the Netherlands). Each participant will asked to complete a series of 20 hypothetical patient summaries in an online task.

• Study Type: Observational
• Enrollment (Actual): 250

Contacts and Locations

Study Locations

• Belgium
  • Antwerp, Belgium
    • University of Antwerp
• Germany
  • Mainz, Germany
    • University of Mainz
• Italy
  • Bologna, Italy
    • University of Bologna
• Netherlands
  • Nijmegen, Netherlands
    • Radboud University Medical Centre
• Switzerland
  • Bern, Switzerland
    • University Hospital of Bern
• United Kingdom
  • London, United Kingdom, W1W 7EJ
    • Marie Curie Palliative Care Research Department

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

A convenience sample of registered General Practitioners (GPs) with a variety of years of experience and seniority across six European countries will be approached to participate

Description

Inclusion Criteria:

• Registered General Practitioner in one of the six participating countries
• Able to read and understand the language in which the questionnaire is presented to them

Exclusion Criteria:

• None

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
General Practitioners; Registered General Practitioners in one of the six participating countries.	Other: Online study; 20 hypothetical patient summaries

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Probability estimate	The continuous estimate of probability of dying within the next 12 months for the SQ (0-100%).	Participants will have up to 8 months (until the study closes) to provide an estimate for each vignette (n=20)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The Surprise Question	Dichotomous response to the SQ (Yes/No)	up to 8 months (until the study closes)Participants will have up to 8 months (until the study closes) to provide a response for each vignette (n=20)
The alternative Surprise Question	Dichotomous response to the alternative SQ (Yes/No)	up to 8 months (until the study closes)Participants will have up to 8 months (until the study closes) to provide a response for each vignette (n=20)
Treatment options	The options for the course of action selected by the participants in each vignette	up to 8 months (until the study closes)Participants will have up to 8 months (until the study closes) to provide a response for each vignette (n=20)

Collaborators and Investigators

• Sponsor: University College, London
• Collaborators: Radboud University Medical Center; University of Bologna; Imperial College London; University of Bern; Johannes Gutenberg University Mainz; Universiteit Antwerpen
• Investigators: Principal Investigator: Patrick Stone, MA, MD, FRCP, University College, London

Publications and helpful links

General Publications

• White N, Oostendorp LJ, Vickerstaff V, Gerlach C, Engels Y, Maessen M, Tomlinson C, Wens J, Leysen B, Biasco G, Zambrano S, Eychmuller S, Avgerinou C, Chattat R, Ottoboni G, Veldhoven C, Stone P. An online international comparison of palliative care identification in primary care using the Surprise Question. Palliat Med. 2022 Jan;36(1):142-151. doi: 10.1177/02692163211048340. Epub 2021 Oct 1.
• White N, Oostendorp L, Vickerstaff V, Gerlach C, Engels Y, Maessen M, Tomlinson C, Wens J, Leysen B, Biasco G, Zambrano S, Eychmuller S, Avgerinou C, Chattat R, Ottoboni G, Veldhoven C, Stone P. An online international comparison of thresholds for triggering a negative response to the "Surprise Question": a study protocol. BMC Palliat Care. 2019 Apr 9;18(1):36. doi: 10.1186/s12904-019-0413-x. Erratum In: BMC Palliat Care. 2020 Jan 27;19(1):15.

Helpful Links

• The Study Protocol

Study record dates

Study Major Dates

• Study Start (ACTUAL): March 25, 2019
• Primary Completion (ACTUAL): March 1, 2020
• Study Completion (ACTUAL): March 1, 2020

Study Registration Dates

• First Submitted: September 25, 2018
• First Submitted That Met QC Criteria: October 3, 2018
• First Posted (ACTUAL): October 5, 2018

Study Record Updates

• Last Update Posted (ACTUAL): March 27, 2020
• Last Update Submitted That Met QC Criteria: March 25, 2020
• Last Verified: March 1, 2020

More Information

Terms related to this study

• Keywords: Prognostication; Surprise Question
• Other Study ID Numbers: 18/0253

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No