The effect of framing on surrogate optimism bias: A simulation study

Area of Science:

• Medical communication
• Decision science
• Bioethics

Background:

• Optimism bias can influence surrogate decision-making for critically ill patients.
• Understanding factors affecting this bias is crucial for improving end-of-life care.

Purpose of the Study:

• To investigate how emotion priming and physician communication strategies affect optimism bias in surrogates.
• To identify communication elements that may mitigate unrealistic optimism.

Main Methods:

• A randomized factorial experiment simulated a family meeting for critically ill patients.
• Surrogates (aged ≥35) estimated prognosis after simulated physician communication.
• Optimism bias was defined as a discrepancy between surrogate and physician prognosis estimates.

Main Results:

• Optimism bias was observed in 30% of surrogates and correlated with choosing cardiopulmonary resuscitation (CPR).
• Emotion priming and physician attention to emotion did not significantly affect optimism bias.
• Framing the decision as the patient's choice and using "allow natural death" (vs. "do not resuscitate") decreased optimism bias.

Conclusions:

• The framing of CPR choices in end-of-life conversations significantly influences surrogate optimism bias.
• Specific communication strategies can be employed to reduce unrealistic optimism during code status discussions.