One question can prompt end-of-life conversations for older emergency care patients, study finds

Researchers from Boston-based Brigham and Women's Hospital have found one question that can help emergency care clinicians identify older patients who are at a greater risk of death, encouraging discussions about end-of-life care.

Asking caregivers the question, "Would you be surprised if this patient died in the next month?" helps hospitals identify patients with a twofold higher risk of dying.

For the study, published recently in JAMA Network Open, researchers analyzed data from a cohort of 10,737 adults, 65 years or older. These adults received care in the emergency department and were subsequently admitted to Maine Medical Center in Portland between Jan. 1, 2014 and Dec. 31, 2015. Of the 10,737 patients, 893 died.

The researchers found that clinicians answered that they would not be surprised if the patient died in the next month for 2,104 of the patients. After controlling for demographic and other variables, researchers found that these patients were 2.4 times as likely to die as those for whom clinicians answered that they would be surprised. Also, clinicians accurately predicted death in the next month 685 times.

"One of the advantages to the 'surprise' question is that it can provoke a conversation about palliative care. If a physician answers, 'No, it would not surprise me if my patient died,' the next thought naturally is, 'What am I going to do about that?'" said Kei Ouchi, MD, a corresponding author on the study and an emergency medicine physician at Brigham and Women's Hospital.

Noting that the study was conducted at one urban academic medical center with a mostly white patient population, the researchers said that generalizing the findings may be difficult.

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