Observational study of agreement between attending and trainee physicians on the surprise question: 'Would you be surprised if this patient died in the next 12 months?'

Autor: Natalie Wong, Shail Rawal, Alex Astell, Michael E. Detsky, Roy Ilan, Laura M. Jewell, Christopher J. Yarnell, James Downar, Rob Fowler, Ruxandra Pinto, John You, Luke A. Devine
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Male
Palliative care
Activities of daily living
Pulmonology
Epidemiology
Health Care Providers
Tertiary Care Centers
0302 clinical medicine
Medical Conditions
Surveys and Questionnaires
Medicine and Health Sciences
Medicine
030212 general & internal medicine
Prospective Studies
Medical Personnel
Prospective cohort study
media_common
Confusion
Chance agreement
Aged
80 and over
Ontario
Academic Medical Centers
Terminal Care
Multidisciplinary
Palliative Care
Middle Aged
Prognosis
Hospitals
3. Good health
Surprise
Professions
Infectious Diseases
Educational Status
Female
medicine.symptom
Research Article
Adult
medicine.medical_specialty
Death Rates
media_common.quotation_subject
Science
03 medical and health sciences
Respiratory Disorders
Population Metrics
Diagnostic Medicine
Physicians
Medical Staff
Hospital
Humans
Hospitals
Teaching
Aged
Population Biology
business.industry
Internship and Residency
Biology and Life Sciences
030208 emergency & critical care medicine
Trainees
Health Care
Health Care Facilities
Family medicine
Medical Risk Factors
People and Places
Respiratory Infections
Observational study
Population Groupings
business
Zdroj: PLoS ONE, Vol 16, Iss 2, p e0247571 (2021)
PLoS ONE
ISSN: 1932-6203
Popis: BackgroundOptimal end-of-life care requires identifying patients that are near the end of life. The extent to which attending physicians and trainee physicians agree on the prognoses of their patients is unknown. We investigated agreement between attending and trainee physician on the surprise question: “Would you be surprised if this patient died in the next 12 months?”, a question intended to assess mortality risk and unmet palliative care needs.MethodsThis was a multicentre prospective cohort study of general internal medicine patients at 7 tertiary academic hospitals in Ontario, Canada. General internal medicine attending and senior trainee physician dyads were asked the surprise question for each of the patients for whom they were responsible. Surprise question response agreement was quantified by Cohen’s kappa using Bayesian multilevel modeling to account for clustering by physician dyad. Mortality was recorded at 12 months.ResultsSurprise question responses encompassed 546 patients from 30 attending-trainee physician dyads on academic general internal medicine teams at 7 tertiary academic hospitals in Ontario, Canada. Patients had median age 75 years (IQR 60–85), 260 (48%) were female, and 138 (25%) were dependent for some or all activities of daily living. Trainee and attending physician responses agreed in 406 (75%) patients with adjusted Cohen’s kappa of 0.54 (95% credible interval 0.41 to 0.66). Vital status was confirmed for 417 (76%) patients of whom 160 (38% of 417) had died. Using a response of “No” to predict 12-month mortality had positive likelihood ratios of 1.84 (95% CrI 1.55 to 2.22, trainee physicians) and 1.51 (95% CrI 1.30 to 1.72, attending physicians), and negative likelihood ratios of 0.31 (95% CrI 0.17 to 0.48, trainee physicians) and 0.25 (95% CrI 0.10 to 0.46, attending physicians).ConclusionTrainee and attending physician responses to the surprise question agreed in 54% of cases after correcting for chance agreement. Physicians had similar discriminative accuracy; both groups had better accuracy predicting which patients would survive as opposed to which patients would die. Different opinions of a patient’s prognosis may contribute to confusion for patients and missed opportunities for engagement with palliative care services.
Databáze: OpenAIRE
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