Prognosis Discordance Prevalent Among Decision-Makers at the End-of-Life

Researchers conducted interviews of patients’ decision-makers to determine how well their understanding of a patient’s prognosis aligned with the physician’s prognostic estimate. The patients were receiving care in the intensive care unit and were identified by physicians as having a high risk of death.

The 229 surrogate decision-makers were primarily family members or friends of patients and served as the decision makers for 174 patients at the University of California, San Francisco Medical Center between 2005 and 2009. The surrogate decision-makers were asked to estimate the patients’ survival chances on a scale of 1 to 100. Researchers found that 53% of the time there was at least a 20% gap in the way the surrogates and physicians viewed a patient's prospects. Surrogates estimated a more optimistic prognosis while the physicians were more accurate in their predictions.

Interestingly, only 17% of the surrogate decision-makers said they had misunderstood information; most said they felt maintaining hope would be helpful to the patient. The researchers concluded that surrogate decision-makers may not want to “hear” what is said about a patient’s prognosis, and instead choose a more hopeful outlook for the patient.

Reference White DB, Emecoff N, Buddadhumaruk P, et al. Prevalence of and factors related to discordance about prognosis between physicians and surrogate decision makers of critically ill patients. JAMA. 2016;315(19):2086-2094.