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Causes and Consequences of Optimistic Expectations About Prognosis by Surrogate Decision-Makers in ICUs

Causes and Consequences of Optimistic Expectations About Prognosis by Surrogate Decision-Makers in ICUs

This multicenter study shows that optimistic expectations about prognosis are prevalent among surrogates of patients with advanced critical illness, arise both from misunderstandings by surrogates and from surrogates holding more hopeful beliefs than what they heard from physicians and are associated with a longer duration of intensive treatment at the end of life.

These findings underscore the need to develop strategies to improve the comprehensibility of physicians’ prognostications, and also to attend to the emotional and psychological challenges surrogates face when confronted with news of a poor prognosis.

Surrogates and physicians completed a validated instrument assessing their prognostic expectations for hospital survival. We determined the proportion of surrogates with optimistic expectations, defined as a prognostic estimate that was at least 20% more optimistic than the physician’s, then determined how frequently this arose from surrogates misunderstanding the physicians’ prognosis versus holding more hopeful beliefs compared with the physician.

Overall, 45% of surrogates held optimistic expectations about prognosis, which arose from a combination of misunderstanding the physician’s prognostic expectations and from holding more hopeful beliefs compared with the physician.

CriticalCare.news
September 5, 2019

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