Send to

Choose Destination
Palliat Med. 2017 Sep;31(8):754-763. doi: 10.1177/0269216316676647. Epub 2016 Nov 4.

Utility of the NECPAL CCOMS-ICO© tool and the Surprise Question as screening tools for early palliative care and to predict mortality in patients with advanced chronic conditions: A cohort study.

Author information

1 The Qualy Observatory/WHO Collaborating Centre for Public Health Palliative Care Programs (WHOCC), Catalan Institute of Oncology (CIO), Department of Health (DoH), Barcelona, Spain.
2 Chair of Palliative Care, University of Vic, Barcelona, Spain.
3 Programme for the Prevention and Care of Patients with Chronic Conditions, Department of Health (DoH), Government of Catalonia, Barcelona, Spain.
4 Hospital de la Santa Creu, Hospital General de Vic, Barcelona, Spain.
5 Institut Català de la Salut - SAP Osona, Barcelona, Spain.
6 CAP El Remei (Vic Sud), Barcelona, Spain.
7 Department of Economics and Business, University of Vic, Barcelona, Spain.
8 Department of Health (DoH), Government of Catalonia, Barcelona, Spain.



The Surprise Question (SQ) identifies patients with palliative care needs. The NECPAL CCOMS-ICO© (NECPAL) tool combines the Surprise Question with additional clinical parameters for a more comprehensive assessment. The capacity of these screening tools to predict mortality is still unknown.


To explore the predictive validity of the NECPAL and SQ to determine 12- to 24-month mortality.


Longitudinal, prospective and observational cohort study.


Three primary care centres, one general hospital, one intermediate care centre, and four nursing homes. Population cohort with advanced chronic conditions and limited life prognosis. Patients were classified according to SQ and NECPAL criteria and followed for 24 months.


Data available to assess 1059 of 1064 recruited patients (99.6%) at 12 and 24 months: 837 patients were SQ+ and 780 were NECPAL+. Mortality rates at 24 months were as follows: 44.6% (SQ+) versus 15.8% (SQ-) and 45.8% (NECPAL+) versus 18.3% (NECPAL-) ( p = 0.000). SQ+ and NECPAL+ identification was significantly correlated with 24-month mortality risk (hazard ratios: 2.719 and 2.398, respectively). Both tools were highly sensitive (91.4, CI: 88.7-94.1 and 87.5, CI: 84.3-90.7) with high negative predictive values (84.2, CI: 79.4-89.0 and 81.7, CI: 77.2-86.2), with low specificity and positive predictive value. The prognostic accuracy of SQ and NECPAL was 52.9% and 55.2%, respectively. The predictive validity was slightly better for NECPAL.


SQ and NECPAL are valuable screening instruments to identify patients with limited life prognosis who may require palliative care. More research is needed to increase its prognostic utility in combination with other parameters.


Palliative care; health services needs and demands; mortality; patient care planning; prognosis; risk assessment

[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Atypon
Loading ...
Support Center