Background: To help general practitioners (GPs) in early identification of patients with palliative care (PC) needs, this pilot study aimed to determine the potential of the combined original surprise question (SQ1) ('Would I be surprised if this patient died within the next 12 months?') and the second surprise question (SQ2) ('Would I be surprised if this patient was still alive after 12 months?'). We hypothesized that answering these SQs would trigger them to make a multidimensional care plan.
Methods: 26 Slovenian GPs, randomized into 4 groups, were invited to write a care plan for each of the four patients described in case vignettes (2 oncologic, 1 organ failure and 1 frailty case). GPs in group 1 were only asked to write a care plan for each patient. GPs in group 2 answered SQ1 and GPs in groups 3 and 4 answered SQ1 and SQ2 before writing the care plan. The type and number of PC aspects mentioned in the respective care plans were quantified into a numeric RADboud ANTicipatory (RADIANT) score.
Results: Mean RADIANT scores in groups 1-4 were 2.2, 3.6, 2.5 and 3.1, respectively. When comparing the different vignettes, vignette B (terminal oncologic patient) scored best (3.6). Mean RADIANT scores in groups 3 and 4 were slightly higher for GPs who would be surprised compared to GPs who would not be surprised if the patient was still alive in 12 months.
Conclusion: The combined SQs were considered helpful in the early identification of patients in need of PC in Slovenian general practice.
Uvod: Namen te študije kot pomoč splošnim zdravnikom (SZ) pri zgodnjem prepoznavanju pacientov s potrebo po paliativni oskrbi (PO) je določanje potenciala kombiniranega izvirnega vprašanja presenečenja (VP1): »Ali bi me presenetilo, če bi pacient umrl v naslednjih 12 mesecih?« ter drugega vprašanja presenečenja (VP2): »Ali bi me presenetilo, če bi bil ta pacient živ čez 12 mesecev?« Naša hipoteza temelji na domnevi, da bi odgovarjanje na ti dve VP sprožilo pripravo večdimenzionalnega načrta oskrbe.
Metode: Šestindvajset slovenskih SZ, ki so bili naključno razvrščeni v štiri skupine, smo prosili, naj pripravijo načrt oskrbe za vsakega od štirih pacientov, ki so bili opisani v vinjetah s primeri (2 onkoloska primera, 1 odpoved organov in 1 primer krhkosti). SZ v 1. skupni so morali napisati poročilo o oskrbi za vsakega pacienta. SZ v 2. skupini so odgovorili na VP1, SZ v 3. in 4. skupini pa so odgovorili na VP1 in VP2, preden so pričeli pripravljati načrt oskrbe. Vrsta in število stališč PO, ki so bili omenjeni v načrtih oskrbe, so bili izmerjeni v numerični rezultat RADboud ANTicipatory (RADIANT).
Rezultati: Povprečni rezultati RADIANT od 1. do 4. skupine so bili 2,2, 3,6, 2,5 in 3,1. Pri primerjanju različnih vinjet je vinjeta B (umirajoči onkološki pacient) pridobila najboljši rezultat (3,6). Povprečni rezultati RADIANT v 3. in 4. skupini so bili rahlo višji pri SZ, ki bi bili presenečeni, v primerjavi s SZ, ki ne bili presenečeni, če bi bil pacient še vedno živ čez 12 mesecev.
Zaključek: Kombinirana VP pripomorejo k zgodnjemu prepoznavanju pacientov s potrebo po PO v splošni zdravstveni oskrbi v Sloveniji.
Keywords: Slovenia; cancer; dementia; frail elderly; general practitioners; organ failure; palliative care; surprise question.