Large Discrepancies in Surrogates and Physician's Prognosis of Critically Ill
HealthDay News — In more than half of recently studied cases, doctors and family members acting on behalf of critically ill patients disagreed about whether the patient would die or not, according to a study published in the May 17 issue of the Journal of the American Medical Association.
Douglas White, MD, a professor of critical care medicine at the University of Pittsburgh Medical Center, and colleagues surveyed 229 people – primarily family members or friends – who had served as "decision makers" for 174 intensive care patients at the University of California-San Francisco Medical Center between 2005 and 2009. All were asked to estimate their loved one's survival chances on a scale of 1 to 100. After comparing surrogate answers to those of 99 physicians on duty, 53% of the time there was at least a 20% gap in the way surrogates and doctors viewed a patient's prospects.
Surrogates gravitated toward more optimistic prognoses. But the doctors were found to have expressed more accurate views, given the ultimate outcomes. Among surrogates who expressed overly optimistic views, only 17% said they had misunderstood medical information. Roughly one-third maintained a more positive view than the physician, despite having understood the information provided. Almost half of those 71 surrogates said they felt that maintaining hope was helpful to the patient. About one-third referenced their more intimate knowledge of the patient's capabilities, while a little more than one-quarter cited their religious beliefs.
Elie Azoulay, MD, PhD, lead author of an accompanying editorial in the journal, and deputy director of the intensive care medical unit at Saint-Louis Hospital in Paris, suggested that physicians view the family-doctor divide "as an opportunity to change our way to communicate, better address family needs, and provide active listening." Doctors should talk less and listen more, while providing loved ones "with opportunities to voice concerns, vent emotions, or sometimes just to be there with the team without hearing or saying a word," Azoulay told HealthDay.