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Screening with the double surprise question to predict deterioration and death: an explorative study.
BMC Palliative Care ( IF 2.5 ) Pub Date : 2019-12-27 , DOI: 10.1186/s12904-019-0503-9
C M M Veldhoven 1, 2 , N Nutma 1 , W De Graaf 2 , H Schers 3 , C A H H V M Verhagen 1 , K C P Vissers 1 , Y Engels 1
Affiliation  

BACKGROUND Early identification of palliative patients is challenging. The Surprise Question (SQ1; Would I be surprised if this patient were to die within 12 months?) is widely used to identify palliative patients. However, its predictive value is low. Therefore, we added a second question (SQ2) to SQ1: 'Would I be surprised if this patient is still alive after 12 months?' We studied the accuracy of this double surprise question (DSQ) in a general practice. METHODS We performed a prospective cohort study with retrospective medical record review in a general practice in the eastern part of the Netherlands. Two general practitioners (GPs) answered both questions for all 292 patients aged ≥75 years (mean age 84 years). Primary outcome was 1-year death, secondary outcomes were aspects of palliative care. RESULTS SQ1 was answered with 'no' for 161/292 patients. Of these, SQ2 was answered with 'yes' in 22 patients. Within 12 months 26 patients died, of whom 24 had been identified with SQ1 (sensitivity: 92%, specificity: 49%). Ten of them were also identified with SQ2 (sensitivity: 42%, specificity: 91%). The latter group had more contacts with their GP and more palliative care aspects were discussed. CONCLUSIONS The DSQ appears a feasible and easy applicable screening tool in general practice. It is highly effective in predicting patients in high need for palliative care and using it helps to discriminate between patients with different life expectancies and palliative care needs. Further research is necessary to confirm the findings of this study.

中文翻译:

用双重惊奇问题进行筛查以预测恶化和死亡:一项探索性研究。

背景技术姑息性患者的早期识别具有挑战性。惊喜问题(SQ1;如果该患者在12个月内死亡,我会感到惊讶吗?)被广泛用于识别姑息性患者。但是,其预测值较低。因此,我们在SQ1中增加了第二个问题(SQ2):“如果这名患者在12个月后还活着,我会感到惊讶吗?” 我们在一般实践中研究了这个双重惊喜问题(DSQ)的准确性。方法我们在荷兰东部进行了一项前瞻性队列研究,并回顾性回顾了病历。两名全科医生(GPs)对所有年龄≥75岁(平均年龄84岁)的292名患者回答了这两个问题。主要结局为1年死亡,次要结局为姑息治疗的方面。结果SQ1的回答为“ 否”适用于161/292患者。其中,对22例患者的SQ2回答为“是”。在12个月内死亡26例患者,其中24例被确定患有SQ1(敏感性:92%,特异性:49%)。其中十个也被鉴定为SQ2(敏感性:42%,特异性:91%)。后者与他们的全科医生有更多联系,并讨论了更多的姑息治疗方面。结论在一般实践中,DSQ似乎是一种可行且容易应用的筛查工具。它可以有效地预测需要高度姑息治疗的患者,并有助于区分预期寿命和姑息治疗需求不同的患者。需要进一步的研究来确认这项研究的结果。在12个月内死亡26例患者,其中24例被确定患有SQ1(敏感性:92%,特异性:49%)。其中十个也被鉴定为SQ2(敏感性:42%,特异性:91%)。后者与他们的全科医生有更多联系,并讨论了更多的姑息治疗方面。结论在一般实践中,DSQ似乎是一种可行且容易应用的筛查工具。它可以有效地预测需要高度姑息治疗的患者,并有助于区分预期寿命和姑息治疗需求不同的患者。需要进一步的研究来确认这项研究的结果。在12个月内死亡26例患者,其中24例被确定患有SQ1(敏感性:92%,特异性:49%)。其中十个也被鉴定为SQ2(敏感性:42%,特异性:91%)。后者与他们的全科医生有更多联系,并讨论了更多的姑息治疗方面。结论在一般实践中,DSQ似乎是一种可行且容易应用的筛查工具。它可以有效地预测需要高度姑息治疗的患者,并有助于区分预期寿命和姑息治疗需求不同的患者。需要进一步的研究来确认这项研究的结果。后者与他们的全科医生有更多联系,并讨论了更多的姑息治疗方面。结论在一般实践中,DSQ似乎是一种可行且容易应用的筛查工具。它可以有效地预测需要高度姑息治疗的患者,并有助于区分预期寿命和姑息治疗需求不同的患者。需要进一步的研究来确认这项研究的结果。后者与他们的全科医生有更多联系,并讨论了更多的姑息治疗方面。结论在一般实践中,DSQ似乎是一种可行且容易应用的筛查工具。它可以有效地预测需要高度姑息治疗的患者,并有助于区分预期寿命和姑息治疗需求不同的患者。需要进一步的研究来确认这项研究的结果。
更新日期:2019-12-30
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