3-Day Surprise Question to predict prognosis of advanced cancer patients with impending death: Multicenter prospective observational study

Background The study aimed to clarify the efficacy of the 3-Day Surprise Question (3DSQ) in predicting the prognosis for advanced cancer patients with impending death. Patients and Methods This study was a part of multicenter prospective observational study which investigated the dying process in advanced cancer patients in Japan. For patients with a Palliative Performance Scale <= 20, the 3DSQ Would I be surprised if this patient died in the next 3 days? was answered by their physicians. In addition to the sensitivity and specificity of the 3DSQ, the characteristics of patients who survived longer than expected were examined via multivariate analysis. Results Among the 1896 patients enrolled, 1411 were evaluated. Among 1179 (83.6%) patients who were classified into the Not surprised group, 636 patients died within 3 days. Among 232 (16.4%) patients of Yes surprised group, 194 patients lived longer than 3 days. The sensitivity, specificity, positive predictive value, and negative predictive value of the 3DSQ were 94.3% (95% confidence interval [CI]: 92.7% to 95.8%), 26.3% (95% CI: 24.8% to 27.6%), 53.9% (95% CI: 53.0% to 54.7%), and 83.6% (95% CI: 78.7% to 87.7%), respectively. Multivariate analysis showed palpable radial artery, absent respiration with mandibular movement, SpO(2) >= 90%, opioid administration, and no continuous deep sedation as characteristics of patients who lived longer than expected. Conclusions The 3-Day Surprise Question can be a useful screening tool to identify advanced cancer patients with impending death.

Automated summary

The study found that the 3-Day Surprise Question can be a useful screening tool to identify advanced cancer patients with impending death. By answering this question, physicians can have a certain predictive ability on the prognosis of patients, and multivariate analysis also revealed the characteristics of patients who lived longer than expected.