The "surprise" question in Nephrology

"Would I be surprised if this patient died in the next year?" is the surprise question. This notion has made way into the palliative care and nephrology world thanks to it's introduction by Dr.Alvin Moss. Recent news has mentioned this concept as well. A study published in CJASN in 2008 showed that the answer to this question was more predictive of identifying sicker patients on dialysis who have a risk of early mortality and need for palliative care consults.  In this study, the group that answered "no" to the question had higher mortality, older patients and more co morbid conditions.  The surprise question predicted status at 1 year better than age, time on dialysis, gender, hemoglobin, serum albumin, and quality of life scores. Given this surprising simple question as a good screening tool, many other fields of medicine such as pulmonary and oncology have embraced this technique. These studies tell us that the most important is learning how to assess the patient's prognosis.  A touchcalc program utilizes this method in the mortality calculation as well. Please review the RPA summary on palliative care for dialysis patients and shared decision making.