Surrogate decision makers more optimistic about prognosis than physicians: JAMA
Patients’ physicians and surrogate decision makers have conflicting expectations about the prognosis of critically ill patients. In a study published in the May 17 issue of JAMA, Douglas White, MD, from the Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pennsylvania and coauthors report that physician-surrogate discordance about prognosis of patients in ICUs occurred in 53% (122/229).
Of the 122 instances, discordance was related to both misunderstandings by surrogates and differences in belief about the patient’s prognosis in 65 instances (28%), 38 (17%) were from misunderstandings by surrogates only, 7 (3%) were related to differences in belief alone. No data were available for the remaining 12 cases. Seventy-five patients (43%) died.
The physicians’ prognostic estimates were statistically significantly more accurate than those of surrogates’. Seventy-one surrogates interviewed were more optimistic about the prognosis than physicians. The most common reasons cited for optimism were a need to maintain hope to benefit the patient (n = 34) or they felt that their patient had unique strengths not yet known to the physician (n = 24), and religious belief (n = 19).
The prospective study involved 229 decision makers, 99 physicians, and 174 critically ill, incapacitated patients.
The question put to both physicians and surrogates was "What do you think are the chances that the patient will survive this hospitalization if the current plan of care stays the same?" Surrogates were also asked what they thought the physician's response would be.
These findings suggest while it is important to improve the comprehensibility of prognostic information it is also equally important to address the emotional and psychological factors that influence the expectations of the surrogates regarding prognosis of their patients.