Question 1

What if different clinicians give different answers to the Surprise Question?

Accepted Answer

Disagreement between clinicians is informative. The Surprise Question is inherently subjective, reflecting each clinician's insight into the patient. When there is disagreement, err on the side of a 'No' response (i.e., proceed with palliative assessment). Discussing the Surprise Question as a team can be a useful trigger for shared decision-making.

Question 2

Does the Surprise Question work for non-cancer patients?

Accepted Answer

Yes — the Surprise Question has been validated in heart failure, COPD, renal disease, dementia, and general frail older populations. Its sensitivity varies by population but is generally higher for cancer than for organ failure, where the disease trajectory is less predictable.

Question 3

How often should the Surprise Question be asked?

Accepted Answer

The Surprise Question should be reconsidered at each significant clinical encounter or at least every 6–12 months for patients with chronic life-limiting illness. A change in answer from 'Yes' to 'No' over time signals disease progression and should trigger an updated care plan.

Question 4

Is the Surprise Question sufficient alone to trigger palliative referral?

Accepted Answer

No — the Surprise Question is a screening tool, not a referral criterion. A 'No' response should prompt further assessment using a tool like SPICT or clinician judgement before formal palliative referral. This avoids overwhelming specialist services with inappropriate referrals while ensuring no patient with unmet needs is missed.