Survival Estimates for Critically Ill Patients Vary Between Physicians and Decision-Makers

Estimated survival time for critically ill patients significantly differ in more than half of family and friends in a decision-making role, and the physicians who treat these patients.

A majority of the differences were found to be attributed to the decision-maker having fundamentally different and overly optimistic beliefs on patient prognosis. Researchers believe the study’s findings, published in the Journal of the American Medical Association, will help train physicians to better communicate with the family and friends of the patient.

“It isn't a bad thing for a patient's family and friends to have hope that they will recover," said lead study author Douglas B. White, MD, MAS. “However, it is problematic when those overly optimistic expectations result in more invasive treatments in dying patients and delayed integration of palliative care that can alleviate suffering.”

The study surveyed 229 people between 2005 and 2009, who agreed to be the surrogate decision-maker for patients hospitalized in 4 intensive care units at San Francisco Medical Center. Also surveyed were the physicians caring for the patients the surrogates were making decisions for.

Typically, the surrogates were friends and family of the patient. On a scale from 0 to 100, with 0 rated as no chance of survival and 100 as definite survival, the survey asked both the surrogates and the physicians to estimate the chance of the patient surviving hospitalization.

The results of the study found that 53% of cases had answers that differed by 20%. A majority of the surrogates were more optimistic than the physicians, but the physician’s prognosis estimates were found to be far more accurate.

Since the 2 groups were unaware of one another’s answers, the surrogates were asked to guess what they thought the physicians had answered. Generally, the surrogates guessed somewhere in between their own estimates and the physician estimates.

The study showed that the surrogates were aware they were being more optimistic.

The reasoning behind this had several answers, but the most common was that the surrogates believed that if they maintained hope, the patient would do better than expected. They also believed they knew the patient better than the physician, and thought the patient had more strength than the physician was aware of.

Religious beliefs were also a reason for optimism.

“As doctors, we want to provide the best possible care for our patients,” White said. “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.”