The utility and value of the "surprise question" for patients with serious illness

Clinicians have long identified the challenges of accurately making a prognosis as being a barrier to patient access to end-of-life care,1 and many tools have been developed to help clinicians with the process.2 These tools generally rely on algorithms that can be complex and not easily used in a clinical setting, but as noted in a recent systematic review by Downar and colleagues,3 the surprise question ("Would I be surprised if this patient were to die within the next 12 months?") has gained support as a simple, practical way of identifying patients at high risk of dying.Putting hospice and palliative care together as being only appropriate for the end-of-life care is misleading.Can we predict which hospitalised patients are in their last year of life? A prospective cross-sectional study of the Gold Standards Framework Prognostic Indicator Guidance as a screening tool in the acute hospital setting.