Challenges in the integration of palliative care for patients with hematologic malignancies: an analysis of the surprise question in a prospective cohort study.

Background: The Surprise Question (SQ), "Would I be surprised if this patient were to die in the next 12 months?", identifies patients at high risk of death who might benefit from palliative care (PC). However, little is known about its application in oncohematology.

Objectives: To evaluate the performance of the SQ among inpatients with hematologic malignancies.

Design and setting: A prospective cohort study was conducted between September and December 2021, including patients admitted to the Hematology Ward of the University Hospital in Salvador, Brazil.

Methods: Physicians answered the SQ (not surprised (SQ+) or surprised (SQ-)). Mortality data were assessed after one year.

Results: Eighty-one patients were included (56% SQ+ and 44% SQ-). At study closure, 36 patients (44%) had died. Median survival was 10.8 months (95%CI = 9.7-11.8) for SQ- and 5.6 months (95%CI = 4.1-7.1) for SQ+. Sensitivity was 86.1%, specificity 68.9%, positive predictive value 68.8%, negative predictive value 86.1%, and accuracy 76.5%. At the time of the interview, only 15 (18.5%) patients had consulted a PC specialist. By the study's end, 48% had been referred to PC. These patients had poorer performance status (82% vs. 40%, P < 0.001) and more advance care planning records (87% vs. 14%, P < 0.001).

Conclusions: Despite the prognostic uncertainty of hematologic malignancies, the SQ effectively estimates mortality and serves as a valuable tool for early PC integration in oncohematology.