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Contributors to Intensive Care Unit Clinicians' Predictions of Patient Outcomes: A Qualitative Analysis
Anna E Buehler1, Isabella V Ciuffetelli1, Aaron M Delman1
1Anna E. Buehler is a medical student, University of California San Diego School of Medicine, San Diego, California, and a research assistant, Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. Isabella V. Ciuffetelli is a medical student, McGovern Medical School, University of Texas, Houston, Texas. Aaron M. Delman is a general surgery resident, University of Cincinnati School of Medicine, Cincinnati, Ohio. Saida A. Kent is a medical student, University of Kentucky College of Medicine, Lexington, Kentucky. Dominique F. Bayard is an attending physician, Pulmonary and Critical Care of Atlanta, Atlanta, Georgia. Elizabeth Cooney is director of research operations, PAIR Center, University of Pennsylvania. Scott D. Halpern is director, PAIR Center; senior fellow, Leonard Davis Institute of Health Economics; professor, Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine; attending physician, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine; and professor, Department of Medical Ethics and Health Policy, University of Pennsylvania. Michael E. Detsky is affiliated faculty, PAIR Center; attending physician, Sinai Health System, Toronto, Ontario, Canada; and an assistant professor of medicine, University of Toronto, Toronto, Ontario, Canada.
Background:
Information about a critically ill patient's prognosis is important to the shared decision-making process. The factors that physicians and nurses consider when generating their prognoses are not well understood.
Objective:
To explore the factors that intensive care unit clinicians consider when prognosticating for their patients.
Methods:
Intensive care unit clinicians (physicians and nurses) were asked to predict 6-month survival and describe the patient-related factors that they considered in their prognoses. The reported factors were tallied and compared with predictions of 6-month survival or death and with correct and incorrect predictions.
Results:
Physicians and nurses completed 254 and 286 surveys, respectively, for 303 patients. Of 23 factors identified, the 3 most frequently reported were acute conditions, medical history and comorbid conditions, and trajectory. For patients predicted to be alive at 6 months, physicians commonly mentioned the factors procedures and age; nurses mentioned behavior patterns, previous experiences, and social support. For patients predicted to be dead at 6 months, both groups commonly mentioned cancer. Factors with the highest ratios of correct to incorrect predictions reported by physicians were procedures and definitive treatment; those reported by nurses were procedures, behavior patterns, and current functional status.
Conclusions:
Intensive care unit clinicians use various patient factors to inform their prognoses. Clinicians use different factors when predicting survival than when predicting death. Some factors are reported more frequently for correct predictions than for incorrect predictions.