“Would you be surprised if this resident died in the next 3 months?” Using the ‘Surprise Question’ to Identify Long-Term Care Residents Who Could Benefit from a Palliative Care Approach
As part of a research project, which started data collection in September 2014, this will be one of three questions RAI-MDS* coordinators will ask their interprofessional team members during care plan meetings. Known as the “surprise question”, it has been used in acute care and other clinical settings as a way to identify patients who are at high risk for early mortality and should receive priority for palliative care interventions.
Dr. Jill Rice, Jennifer Ellis, RN, PhD, and Dr. José Pereira are leading a study with the Ontario Centres for Learning, Research and Innovation in Long-Term Care (CLRI) and Bruyère Research Institute (BRI) that is being conducted at a large urban long-term care (LTC) home in the Ottawa area. The study’s main purpose is to explore the use of the “surprise question” in order to identify residents in LTC who are believed to have less than six months to live and could therefore likely benefit from incorporating a palliative care approach in their care plan. Residents in this particular LTC home receive a quarterly RAI assessment which includes a review and discussion of their care plan by their health care workers (physicians, nurses, personal support workers, physiotherapists, dieticians, etc.). The study will use these meetings to ask modified versions of the “surprise question” which better reflect the shorter length of stay in LTC.
The three different versions are “Would you be surprised if this resident died in the next…”
a) 3 months,
b) 6 months, and
c) before winter.
Staff responses will be analyzed with RAI-MDS data and results will indicate whether these variations of the “surprise question” are appropriate for use in LTC. In addition, the demographics (staff traits), accuracy, confidence, and comfort will be tested. Afterwards, focus groups or telephone interviews will be used to acquire staff feedback on use of this tool. Results are expected in Spring 2015.
* RAI-MDS (Resident Assessment Instrument – Minimum Data Set) is an electronic care management tool that helps health professionals in long-term care to assess and monitor the care needs of their residents. It is designed to report function and cognitive performance, indicators of social supports and other resident characteristics. Information from the tool is used to develop and modify individualized, resident-centred care plans based on the changing and complex health status of a resident.
Action Update is a monthly member newsletter produced by the Ontario Association of Non-Profit Homes and Services for Seniors (OANHSS).