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Cohort study
The ‘surprise’ question may improve the accuracy of GPs in identifying death in patients with advanced stage IV solid-cell cancer
  1. Joel Rhee1,
  2. Josephine M Clayton2,3
  1. 1UNSW Australia—School of Public Health and Community Medicine, Sydney, New South Wales, Australia
  2. 2HammondCare Palliative and Support Services, Greenwich Hospital, Sydney, New South Wales, Australia
  3. 3University of Sydney—Sydney Medical School, Sydney, New South Wales, Australia
  1. Correspondence to : Dr Joel Rhee, UNSW Australia—School of Public Health and Community Medicine, Sydney, NSW 2052, Australia;

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The ‘surprise’ question has been developed in order to improve the ability of clinicians to identify patients who are at risk of dying in the near future. The question, ‘Would I be surprised if this patient died in the next year?’ shifts the focus away from precise identification of dying patients to identifying patients who might be dying.1 This may enable more patients to receive timely assessment and planning for their supportive care needs.


This is a single-group prospective cohort study aimed at determining the accuracy of the ‘surprise’ question in identifying patients at risk of death. The population examined was patients with stage IV solid-cell cancers cared for by general practitioners (GPs). A random sample of 50 GPs from a local chapter of a GP organisation in Italy was invited to …

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  • Contributors JR and JMC have contributed to the planning and writing of this paper.

  • Competing interests None.

  • Provenance and peer review Commissioned; internally peer reviewed.