Discrepancy in responses to the surprise question between hemodialysis nurses and physicians, with focus on patient clinical characteristics: A comparative study

IntroductionThe surprise question (SQ) Would I be surprised if this patient died within the next xx months can be used by different professions to foresee the need of serious illness conversations in patients approaching end of life. However, little is known about the different perspectives of nurses and physicians in responses to the SQ and factors influencing their appraisals. The aim was to explore nurses' and physicians' responses to the SQ regarding patients on hemodialysis, and to investigate how these answers were associated with patient clinical characteristics. MethodsThis comparative cross-sectional study included 361 patients for whom 112 nurses and 15 physicians responded to the SQ regarding 6 and 12 months. Patient characteristics, performance status, and comorbidities were obtained. Cohen's kappa was used to analyze the interrater agreement between nurses and physicians in their responses to the SQ and multivariable logistic regression was applied to reveal the independent association to patient clinical characteristics. FindingsProportions of nurses and physicians responding to the SQ with no, not surprised was similar regarding 6 and 12 months. However, there was a substantial difference concerning which specific patient the nurses and physicians responded no, not surprised, within 6 (kappa = 0.366, p < 0.001, 95% CI = 0.288-0.474) and 12 months (kappa = 0.379, p < 0.001, 95% CI = 0.281-0.477). There were also differences in the patient clinical characteristics associated with nurses' and physicians' responses to the SQ. DiscussionNurses and physicians have different perspectives in their appraisal when responding to the SQ for patients on hemodialysis. This may reinforce the need for communication and discussion between nurses and physicians to identify the need of serious illness conversations in patients approaching the end of life, in order to adapt hemodialysis care to patient preferences and needs.

Automated summary

This study investigated the responses of nurses and physicians to the surprise question (SQ) for hemodialysis patients, and explored the association between these responses and patient clinical characteristics. The findings revealed that nurses and physicians had different perspectives in their appraisal when responding to the SQ, and there were also differences in the patient clinical characteristics associated with their responses. This highlights the need for communication and discussion between nurses and physicians to adapt hemodialysis care to patient preferences and needs.