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Surprise Question Answer Change Triggers — SCE Palliative Medicine MCQ

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EasyNon-Malignant Palliative CareSurprise Question Answer Change TriggersSCE Palliative Medicine

A 78-year‑old man with advanced heart failure has been stable for 3 months but his GP notices the Surprise Question answer has changed from ‘yes’ to ‘no’. What actions should this trigger?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Initiate advance care planning, consider adding to the palliative care register, review treatment escalation plans, and involve specialist palliative care for symptom assessment

A change in the Surprise Question answer from ‘yes’ ('would be surprised') to ‘no’ is a validated trigger for structured action—not crisis management or inaction. UK GSF guidance mandates multidisciplinary review and timely advance care planning conversations. Patients should be considered for the palliative care register, treatment escalation plans reviewed, and specialist palliative care involved as needed. Option B is too aggressive without acute decline. Option E is prognostically inaccurate. Option D neglects the question’s clinical purpose. Option A is unsafe without clinical review.

Reference: Gold Standards Framework – Proactive Identification Guidance; Mersey Care NHS Foundation Trust, Palliative and end of life care for adults, 2026; NHS clinical pathway guidance on using the Surprise Question, 2025. https://www.merseycare.nhs.uk/eolc