Doubt and belief in physicians’ ability to prognosticate during critical illness: The perspective of surrogate decision makers
Open accessAbstract
OBJECTIVES: Although discussing a prognosis is a duty of physicians caring for critically ill patients, little is known about surrogate decision-makers' beliefs about physicians' ability to prognosticate. We sought to determine: 1) surrogates' beliefs about whether physicians can accurately prognosticate for critically ill patients; and 2) how individuals use prognostic information in their role as surrogate decision-makers. DESIGN, SETTING, AND PATIENTS: Multicenter study in intensive care units of a public hospital, a tertiary care hospital, and a veterans' hospital. We conducted semistructured interviews with 50 surrogate decision-makers of critically ill patients. We analyzed the interview transcripts using grounded theory methods to inductively develop a framework to describe surrogates' beliefs about physicians' ability to prognosticate. Validation methods included triangulation by multidisciplinary analysis and member checking. MEASUREMENTS AND MAIN RESULTS: Overall, 88% (44 of 50) of surrogates expressed doubt about physicians' ability to prognosticate for critically ill patients. Four distinct themes emerged that explained surrogates' doubts about prognostic accuracy: a belief that God could alter the course of the illness, a belief that predicting the future is inherently uncertain, prior experiences where physicians' prognostications were inaccurate, and experiences with prognostication during the patient's intensive care unit stay. Participants also identified several factors that led to belief in physicians' prognostications, such as receiving similar prognostic estimates from multiple physicians and prior experiences with accurate prognostication. Surrogates' doubts about prognostic accuracy did not prevent them from wanting prognostic information. Instead, most surrogate decision-makers view physicians' prognostications as rough estimates that are valuable in informing decisions, but are not determinative. Surrogates identified the act of prognostic disclosure as a key step in preparing emotionally and practically for the possibility that a patient may not survive. CONCLUSIONS: Although many surrogate decision-makers harbor some doubt about the accuracy of physicians' prognostications, they highly value discussions about prognosis and use the information for multiple purposes.
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Surrogates' own prognostic estimates may have served as illocutionary acts-expressions intended to express positive attitude, optimism, or faith; highlight patients' unrecognized qualities of resilience; or counter clinicians' pessimism.
“their own prognostic estimates may also have served as “illocutionary acts”—that is, expressions distinct from comprehension with which they intended to express positive attitude, optimism, or faith; to highlight patients’ unrecognized qualities of resilience; or to counter clinicians’ pessimism (15, 34–36).”
From Effects of a Personalized Web-Based Decision Aid for Surrogate Decision Makers of Patients With Prolonged Mechanical Ventilation (2019) · cites this paper as [35]
The Results sections “Surrogates’ Use of Prognostic Estimates” and “The Influence of God” describe surrogates holding onto hope and faith despite physicians’ poor prognoses (page numbers unavailable). But the paper does not examine surrogates’ own estimates as expressions distinct from comprehension, or say they intended those estimates to highlight resilience or counter clinicians’ pessimism. (LLM, conf=0.79)
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Cites
Enhancing the quality and credibility of qualitative analysis.
(1999) · PubMed Central · Cited by 4,133 · see citing works
A Controlled Trial to Improve Care for Seriously III Hospitalized Patients
Connors, A. F. (1995) · JAMA · doi:10.1001/jama.274.20.1591 · Cited by 3,416 · see citing works
Use of intensive care at the end of life in the United States: An epidemiologic study*
Angus, D. C., Barnato, A. E., Linde‐Zwirble, W. T., Weissfeld, L. A., Watson, R. S., Rickert, T., & Rubenfeld, G. D. (2004) · Critical Care Medicine · doi:10.1097/01.ccm.0000114816.62331.08 · Cited by 1,157 · see citing works
Giacomini, M. K., Cook, D. J., & for the Evidence-Based Medicine Working Group (2000) · JAMA · doi:10.1001/jama.284.3.357 · Cited by 931 · see citing works
Simple tools for understanding risks: from innumeracy to insight
Gigerenzer, G., & Edwards, A. (2003) · BMJ · doi:10.1136/bmj.327.7417.741 · Cited by 770 · see citing works
Schneiderman, L. J., Gilmer, T., Teetzel, H. D., Dugan, D. O., Blustein, J., Cranford, R., Briggs, K. B., Komatsu, G. I., Goodman-Crews, P., Cohn, F., et al. (2003) · JAMA · doi:10.1001/jama.290.9.1166 · Cited by 661 · see citing works
A National Survey of End-of-life Care for Critically Ill Patients
Prendergast, T. J., CLAESSENS, M. T., & Luce, J. M. (1998) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.158.4.9801108 · Cited by 639 · see citing works
Self-citationWhat do we mean by partnership in making decisions about treatment?
Charles, C. A., Whelan, T. J., & Gafni, A. (1999) · BMJ · doi:10.1136/bmj.319.7212.780 · Cited by 624 · see citing works
What Is Wrong With End‐of‐Life Care? Opinions of Bereaved Family Members
Hanson, L. C., Danis, M., & Garrett, J. M. (1997) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.1997.tb02933.x · Cited by 502 · see citing works
Abbott, K. H., Sago, J., Breen, C. M., Abernethy, A. P., & Tulsky, J. A. (2001) · Critical Care Medicine · doi:10.1097/00003246-200101000-00040 · Cited by 475 · see citing works
Attitude and Self-reported Practice Regarding Prognostication in a National Sample of Internists
Christakis, N. A., & Iwashyna, T. J. (1998) · Archives of Internal Medicine · doi:10.1001/archinte.158.21.2389 · Cited by 434 · see citing works
Impact of a Proactive Approach to Improve End-of-Life Care in a Medical ICU
Campbell, M., & Guzmán, J. A. (2003) · CHEST Journal · doi:10.1378/chest.123.1.266 · Cited by 353 · see citing works
Barry, L. C., Kasl, S. V., & Prigerson, H. G. (2002) · American Journal of Geriatric Psychiatry · doi:10.1097/00019442-200207000-00011 · Cited by 343 · see citing works
Azoulay, É., Pochard, F., Chevret, S., Adrie, C., Annane, D., Bleichner, G., Bornstain, C., Bouffard, Y., Cohen, Y., Feissel, M., et al. (2004) · Critical Care Medicine · doi:10.1097/01.ccm.0000139693.88931.59 · Cited by 272 · see citing works
Hebert, R. S., Dang, Q., & Schulz, R. (2006) · Journal of Palliative Medicine · doi:10.1089/jpm.2006.9.683 · Cited by 263 · see citing works
Thompson, B., Cox, P. N., Antonelli, M. M., Carlet, J. M., Cassell, J., Hill, N. S., Hinds, C., Pimentel, J. M., Reinhart, K., & THIJS, L. G. (2004) · Critical Care Medicine · doi:10.1097/01.ccm.0000126895.66850.14 · Cited by 223 · see citing works
Communication of end-of-life decisions in European intensive care units
Cohen, S. L., Sprung, C. L., Sjökvist, P., Lippert, A. M., Ricou, B., Baras, M., Hovilehto, S., Maia, P., Phelan, D. M. J., Reinhart, K., et al. (2005) · Intensive Care Medicine · doi:10.1007/s00134-005-2742-x · Cited by 185 · see citing works
White, D. B., Engelberg, R. A., Wenrich, M. D., Lo, B., & Curtis, J. R. (2007) · Critical Care Medicine · doi:10.1097/01.ccm.0000254723.28270.14 · Cited by 176 · see citing works
Self-citationCampbell, M., & Guzmán, J. A. (2004) · Critical Care Medicine · doi:10.1097/01.ccm.0000138560.56577.88 · Cited by 172 · see citing works
Conflicts Regarding Decisions to Limit Treatment
Goold, S. D., Williams, B., & Arnold, R. M. (2000) · JAMA · doi:10.1001/jama.283.7.909 · Cited by 144 · see citing works
The Language of Prognostication in Intensive Care Units
White, D. B., Engelberg, R. A., Wenrich, M. D., et al. (2008) · Medical Decision Making · doi:10.1177/0272989x08317012 · Cited by 106 · see citing works
Self-citationRisk communication in the clinical consultation
Thomson, R., Edwards, A., & Grey, J. (2005) · Clinical Medicine · doi:10.7861/clinmedicine.5-5-465 · Cited by 99 · see citing works
Family Perceptions of Prognosis, Silence, and the “Suddenness” of Death
Russ, A. J., & Kaufman, S. R. (2005) · Culture Medicine and Psychiatry · doi:10.1007/s11013-005-4625-6 · Cited by 65 · see citing works
Luce, J. M., & White, D. B. (2007) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200609-1397cp · Cited by 62 · see citing works
Self-citationFamilies' awareness of and response to dying.
Yates, P. M., & Stetz, K. M. (1999) · PubMed · Cited by 55 · see citing works
Flagged first, then by citations
Research works printed but not linked: 4
- [11]Christakis NA Death Foretold: Prophecy and Prognosis in Medical Care 1999 The University of Chicago Press
- [18]Sackett DLRBH Guyatt GH Tugwell P Clinical Epidemiology: A Basic Science for Clinical Medicine 1991 Brown and Company Boston, Little Second Edition
- [28]White DB Engelberg RA Wenrich MD The language of prognostication in intensive care units Med Decis Making In Press PMC2812635 18753685
- [34]Among Wealthy Nations: US stands alone in its embrace of religion The Pew Global Attitudes Project 2002 The Pew Research Center for the People & The Press
Cited by
Sorted by citations
White, D. B., Ernecoff, N., Buddadhumaruk, P., Hong, S., Weissfeld, L., Curtis, J. R., Luce, J. M., & Lo, B. (2016) · JAMA · doi:10.1001/jama.2016.5351 · Cited by 232 · see citing works
Self-citationSurrogate Decision Makers' Interpretation of Prognostic Information: A Mixed-Methods Study
Zier, L. S., Sottile, P. D., Hong, S. Y., Weissfield, L. A., & White, D. B. (2012) · Annals of Internal Medicine · doi:10.7326/0003-4819-156-5-201203060-00008 · Cited by 171 · see citing works
Self-citationCox, C. E., White, D. B., Hough, C. L., Jones, D. M., Kahn, J. M., Olsen, M. K., Lewis, C. L., Hanson, L. C., & Carson, S. S. (2019) · Annals of Internal Medicine · doi:10.7326/m18-2335 · Cited by 152 · see citing works
Self-citationPictures as mementos after perinatal death: a case study
Jesus, R. C. D. A., Benute, G., Bertolassi, N., Barbosa, T., Bolibio, R., Figueiredo, F., Setubal, M. S., Gibelli, M. A., Gomes, A., Ferreira, R., et al. (2022) · International Journal of Palliative Nursing · doi:10.12968/ijpn.2022.28.5.208 · Cited by 5 · see citing works
- Authors
- Zier, L. S., Burack, J. H., Micco, G., Chipman, A. K., Frank, J. A., Luce, J. M., & White, D. B.
- Affiliations
- University of California, San Francisco (US)
- San Francisco General Hospital (US)
- Venue
- Critical Care Medicine
- Published
- 2008-08
- Volume
- 36
- Issue
- 8
- Pages
- 2341-2347
- ISSN
- 0090-3493 (ISSN-L)
- PMC
- PMC2628287
- OpenAlex
- W2078128426
- Cited by
- 129
- References
- 25
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 3 · 2023: 6 · 2022: 11 · 2021: 7 · 2020: 4 · 2019: 14 · 2018: 6 · 2017: 3 · 2016: 13 · 2015: 10 · 2014: 5 · 2013: 9 · 2012: 8
- FWCI
- 7.92
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Critical Care Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- DigitalGeorgetown (Georgetown University Library) (submittedVersion)
- Funders
- National Institutes of Health
- University of California, San Francisco
- National Institute on Aging (K23AG032875)
- National Heart, Lung, and Blood Institute (R56HL088440)
- National Center for Research Resources (KL2RR024130)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Health Professions › Radiological and Ultrasound Technology › Family and Patient Care in Intensive Care Units
- Health Sciences › Health Professions › General Health Professions › Ethics in medical practice
- Keywords
- surrogate decision-making, outcome prediction, critical illness, prognosis communication, intensive care unit, end-of-life decisions
- MeSH terms
- Communication, Critical Care, Decision Making, Family, Female, Humans, Interview, Psychological, Male, Middle Aged, Physician's Role, Prognosis, Religion and Medicine, Proxy, Trust
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