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Decision-Makers Hold Overly Optimistic Expectations for Critically Ill Patient Outcomes

Tue, 05/17/2016

Research published on May 17 in the Journal of the American Medical Association shows that more than half of surrogate decision-makers have significantly different estimates, compared to their doctor's, of the chances that their critically ill loved one will survive. Moreover, the research finds, this discordance is most often due to the decision-maker holding fundamentally different and overly optimistic beliefs about the patient's prognosis. The research team, led by Douglas White, MD, Professor of Critical Care Medicine and Director of the Program on Ethics and Decision Making in Critical Illness, CRISMA Center, interviewed 229 surrogates and 99 doctors, asking each group to give a numeric estimate of the chances that the patient would survive hospitalization. The researchers found that in the majority of cases, the difference between the two prognoses was greater than 20 percent, with the surrogates providing more optimistic estimates, and the doctors' estimates being ultimately more accurate.

The researchers then asked the surrogates to guess what they thought was the doctor's estimate, and the results showed that the surrogates understood they were being more optimistic than what the doctor had been communicating to them. White's team interpreted these results as showing that the surrogates' optimism most likely arose from beliefs regarding the need to maintain hope, beliefs that the patient had strengths unknown to the doctor, as well as religious beliefs.

“As doctors, we want to provide the best possible care for our patients," said White in a press release from the University of Pittsburgh Medical Center. "In critically ill patients, that means we must do a better job communicating with the people who are making decisions for our patients. Given the results of this study, we’re working to develop and test interventions both to improve the comprehensibility of the prognosis doctors give to surrogates, and to better attend to the emotional and psychological factors that may influence the surrogate’s expectations for their loved one’s outcome.”

The article was featured in its issue's JAMA Report. The study has also been mentioned in several media outlets:

At end of life, doctors and families often differ in expectations -- CBS News

For loved ones of critically ill patients, hope often trumps understanding of a physician's prognosis -- Los Angeles Times

Study examines how optimism shapes medical decisions -- Pittsburgh Tribune-Review

How Much Time Is Left? Doctors, Loved Ones Often Disagree -- HealthDay

Family, Physicians Often Disagree About Patient Prognosis -- Medscape

Health Care Proxies Often Overly Optimistic About Their Patients' Prognoses; Better Doctor-Family Communication Needed -- Medical Daily

Family members tend to expect more ‘optimistic’ outcomes on terminal patient -- Pulse Headlines

 

Below is a video summary of the results of the research: