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Published on: October 23, 2020
Surrogate decision makers' interpretation of prognostic information: a mixed-methods study.
Lucas S Zier1, Peter D Sottile, Seo Yeon Hong
1University of California, San Francisco, San Francisco, California 94143-0119, USA.
Annals of Internal Medicine
|March 7, 2012
Summary
Surrogate decision makers often interpret grim prognostic information with optimistic bias. This bias stems from a need for optimism and belief in unknown patient factors, not just misunderstanding.
Area of Science:
- Medical decision-making
- Prognostication in advanced illness
- Health communication
Background:
- Surrogate decision makers for patients with advanced illness frequently exhibit overly optimistic prognostic expectations.
- The reasons behind these optimistic expectations remain poorly understood.
Purpose of the Study:
- To investigate how surrogates interpret prognostic statements.
- To identify factors influencing surrogate interpretation of grim prognostic information.
Main Methods:
- A multicenter, mixed-methods study involving 80 surrogates of critically ill patients in intensive care units.
- Surrogates interpreted 16 prognostic statements using a probability scale, with generalized estimating equations analyzing interpretation trends.
- Semistructured interviews were conducted with 15 surrogates exhibiting optimistic interpretation trends.
Main Results:
- Surrogates accurately interpreted statements with low risk of death but showed optimistic bias for high-risk statements (P < 0.001).
- Interpretations of a "5% chance of surviving" statement were highly variable and optimistic (median 90%) compared to the actual 5% (P < 0.001).
- Interviews revealed two themes: surrogates' need for optimism and belief in unobserved patient factors influencing outcomes.
Conclusions:
- Surrogates' optimistic bias in interpreting prognostications is a significant factor, beyond simple misunderstanding.
- Findings highlight the psychological and cognitive factors influencing surrogate decision-making in critical care.
- Study limitations include eliciting interpretations in an experimental setting, not during actual clinical conversations.
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