Background/Objectives: Patients with haematological malignancies less frequently receive specialist palliative care, although they may have unmet needs for symptom control and alleviating psychosocial and existential burdens. The ‘Surprise’ Question, ‘Would you be surprised if this patient died in the next 12 months?’, helps physicians to identify patients who may benefit from palliative care. We tested the influencing factors of the feasibility of the ‘Surprise’ Question in haemato-oncology outpatients. Methods: We performed a prospective cohort study comparing patients with solid tumours and haematological malignancies. All the patients in the haemato-oncology outpatient clinics of a German university hospital were screened by haemato-oncologists using the ‘Surprise’ Question. Results: A survival analysis was performed on 672 patients (76% with haematological malignancies) at 3 and 12 months. Within one year, 110 patients (16%) died. Of these, 30/52 (58%) were patients with solid tumours, but only 12/53 (23%) patients with haematological malignancies were identified in advance by the ‘Surprise’ Question, which reflects ambiguous test sensitivity. A substantial part of the haematology patients in their last year of life were not identified (77%). The match between the survival estimates and actual outcomes was fair (Cohen’s kappa 0.37). The proximity from prediction to event and the estimating physician rather than patient characteristics influenced the accuracy of the instrument. Conclusions: For the first time, the feasibility of the ‘Surprise’ Question in haematology outpatients was proven. Factors that would improve haemato-oncologists’ clinical intuition should be further explored to facilitate timely conversations about issues important to patients nearing the end of life.
背景/目的：血液系统恶性肿瘤患者较少接受专业姑息治疗，但其症状控制及心理社会与存在性负担缓解的需求可能未得到满足。"意外"问题——"若该患者在接下来12个月内去世，您会感到意外吗？"——有助于医生识别可能受益于姑息治疗的患者。本研究检验了"意外"问题在血液肿瘤门诊患者中实施可行性的影响因素。方法：我们开展了一项前瞻性队列研究，比较实体肿瘤与血液系统恶性肿瘤患者。德国某大学医院血液肿瘤门诊所有患者均由血液肿瘤专科医师采用"意外"问题进行筛查。结果：对672名患者（76%为血液系统恶性肿瘤）进行了3个月和12个月的生存分析。一年内共有110名患者（16%）死亡。其中30/52名（58%）实体肿瘤患者被"意外"问题提前识别，而血液系统恶性肿瘤患者仅12/53名（23%），反映出该测试敏感性的不确定性。大量处于生命末期的血液肿瘤患者未被识别（77%）。生存预测与实际结果的匹配度一般（Cohen's kappa系数0.37）。预测时间与死亡事件的接近程度及评估医师（而非患者特征）影响了该工具的准确性。结论：本研究首次证实了"意外"问题在血液科门诊患者中的可行性。应进一步探索提升血液肿瘤专科医师临床直觉的因素，以促进对临终患者重要议题的及时沟通。
肿瘤(癌症)患者之家