Factors associated with a positive response to the surprise question in complex chronic patients treated by advanced practice nurses in primary care

The “surprise question” (“Would I be surprised if the patient died within the next 12 months?”) is useful to predict the survival of patients and indicate the requirement for further assessment of their palliative care needs. Knowledge of the factors related to healthcare professionals’ response is important to establish the effectiveness of this question to screen for PC needs. The aim of this study is to determine if PC needs, frailty, survival prognosis, complexity, symptom burden, and psychological distress are related to the response of advanced practice nurses to the Surprise Question in a sample of complex chronic patients under primary care. Descriptive cross-sectional study. Advanced practice nurses at eight primary care centers in Andalucia (Spain) randomly selected complex chronic patients aged over 18 years and not enrolled in a PC program. Palliative Care needs (NECPAL-ICO-CCOMS 3.1); symptom burden (Edmonton Symptom Assessment Scale), emotional distress (Detection of Emotional Distress tool); frailty (Frail-VIG); prognosis (Palliative Prognostic Index and PROFUND); and complexity (Charlson Multimorbidity Index, Complex Case Evaluation and Palliative Complexity Index) were evaluated among groups with positive and negative surprise question using bivariate analyses. Multiple regression analyses were conducted to identify predictors of a positive surprise question. The study included 179 patients with mean ± standard deviation age of 80.5 (SD = 9.78) years; 54.8% were female, 81% resided in an urban setting, and 86.6% had a caregiver. Heart disease was present in 37.4% (n = 67) and chronic obstructive pulmonary disease in 27.9% (n = 50). A positive surprise question (not surprised) was recorded in 43.6% (78/179) and was correlated with Barthel (p = .009), Pfeiffer (p = .032) Charlson (p = .009), Frail-VIG (p < .001), PROFUND (p < .001) and Palliative Prognosis Index (p < .001) results. In multiple regression analysis, a positive surprise question was associated with age > 85 years (p = .004); identification of palliative care needs by healthcare professionals (p = .023); history of physical, psychological, or sensory disability (p = .009); severe dyspnea (p = .011); disease severity indicators (p = .024); intensity of interventions (p = .014); and medication for insomnia and anxiety (p = .047). Primary care advanced practice nurses’ response to surprise question is related to frailty, bad prognosis, age > 85 years, previous identification of palliative care, physical or psychological disability, dyspnea, disease severity indicators, and intensity of interventions. Question: Which factors are related to the response of a nursing professional to the surprise question (SQ): “Would I be surprised if the patient died within the next 12 months?” Findings: A positive SQ (not surprised) was related to age over 85 years; identification of palliative care needs by healthcare professionals; history of physical, psychological, or sensory disability; severe dyspnea; certain disease severity indicators; intensity of interventions; and drugs for insomnia and anxiety. Meaning: The SQ might be a useful screening tool for advanced practice nurses to identify care needs in a primary care setting.