Do attending and trainee physicians agree on patient prognoses using the surprise question?
CCCF ePoster library. Yarnell C. Oct 27, 2015; 117339; P23 Disclosure(s): University of Toronto Faculty of Medicine Integrating Challenge Fund
Christopher Yarnell
Christopher Yarnell
Login now to access Regular content available to all registered users.

You may also access this content "anytime, anywhere" with the Free MULTILEARNING App for iOS and Android
Abstract
Rate & Comment (0)
P23


Topic: Survey (quantitative or qualitative)


Do attending and trainee physicians agree on patient prognoses using the surprise question?



Christopher Yarnell, L. Jewell, R. Pinto, R. Fowler

Internal Medicine, University of Toronto, Toronto, Canada | Faculty of Medicine, University of Toronto, Toronto, Canada | Biostatistics, Critical Care, Sunnybrook Health Sciences Centre, Toronto, Canada | Critical Care, Sunnybrook Health Sciences Centre, Toronto, Canada

Introduction: Physician prognostication is fallible and differences in prognoses between attending and trainee physicians may represent an opportunity for education and improved end-of-life care. We assessed prognostic agreement between attending and resident physicians using the surprise question, a validated end-of-life screening tool that asked “Would you be surprised if this patient died during this hospital admission?”

Objectives: We hypothesized that attending and trainee physician would disagree on the prognoses of some of their patients, and that when they disagreed the attending physician would estimate a shorter prognosis.

Methods:

For each patient admitted to the academic internal medicine service we gathered the attending physician and most senior trainee physician responses to the surprise question (“Yes” or “No”) with respect to hospital discharge. We gathered baseline data from the chart and followed up on patient mortality at hospital discharge.



Results: We gathered responses on 105 patients from 6 pairs of attending and trainee physicians. Trainee and attending physician responses agreed in 79% of cases, although there was a high probability of chance agreement (kappa 0.15, 95% CI -0.03 to 0.34). In discordant responses, attending physicians were more likely to respond “No, I would not be surprised if this patient died during this hospital admission” (OR 2.14, 95% CI 0.82 – 6.21). Trainee and attending physician “No” responses were specific (0.90, 95% CI 0.85 to 0.94) but not sensitive (0.57, 95%CI 0.29 to 0.82) for in-hospital mortality with no significant differences between the groups.

Conclusion:

Attending and resident physicians often agree on the in-hospital prognoses of their patients, but when they disagree attending physicians tend to estimate higher likelihood of death. The surprise question served as a specific but not sensitive predictor of in-hospital mortality. Divergent responses to the surprise question may represent an opportunity for both improved end of life care and further trainee learning around the factors that influence prognosis. Future work will assess the validity of these findings among a larger population of attending and trainee physicians as well as assess the agreement and predictive characteristics of the 12-month surprise question.



References: N/A
    This eLearning portal is powered by:
    This eLearning portal is powered by MULTIEPORTAL
Anonymous User Privacy Preferences

Strictly Necessary Cookies (Always Active)

MULTILEARNING platforms and tools hereinafter referred as “MLG SOFTWARE” are provided to you as pure educational platforms/services requiring cookies to operate. In the case of the MLG SOFTWARE, cookies are essential for the Platform to function properly for the provision of education. If these cookies are disabled, a large subset of the functionality provided by the Platform will either be unavailable or cease to work as expected. The MLG SOFTWARE do not capture non-essential activities such as menu items and listings you click on or pages viewed.


Performance Cookies

Performance cookies are used to analyse how visitors use a website in order to provide a better user experience.


Save Settings