“It’s not just what the doctor tells me:” Factors that influence surrogate decision-makers’ perceptions of prognosis*
Open accessAbstract
OBJECTIVE: Physicians and surrogate decision-makers for seriously ill patients often have different views of patients' prognoses. We sought to understand what sources of knowledge surrogates rely on when estimating a patient's prognosis. DESIGN: Prospective, mixed-methods study using face-to-face, semistructured interviews with surrogate decision-makers. SETTING: Four intensive care units at the University of California, San Francisco Medical Center in 2006 to 2007. PARTICIPANTS: Participants were 179 surrogate decision-makers for 142 incapacitated, critically ill patients at high risk for death. MAIN RESULTS: Less than 2% (3 of 179) of surrogates reported that their beliefs about the patients' prognoses hinged exclusively on prognostic information provided to them by physicians. The majority cited other factors in addition to physicians' predictions that also contributed to their beliefs about the patients' prognoses, including perceptions of the patient's individual strength of character and will to live; the patient's unique history of illness and survival; the surrogate's own observations of the patient's physical appearance; the surrogate's belief that their presence at the bedside may improve the prognosis; and the surrogate's optimism, intuition, and faith. For some surrogates, these other sources of knowledge superseded the importance of the physician's prognostication. However, most surrogates endeavored to balance their own knowledge of the patient with physicians' biomedical knowledge. CONCLUSIONS: Surrogates use diverse types of knowledge when estimating their loved ones' prognoses, including individualized attributes of the patient, such as their strength of character and life history, of which physicians may be unaware. Attention to these considerations may help clinicians identify and overcome disagreements about prognosis.
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Few surrogates rely exclusively on physician prognostication when forming their perception of patient prognosis.
“past research showing that few surrogates rely exclusively on physician prognostication when forming their perception of patient prognosis (38)”
From Effects of a Personalized Web-Based Decision Aid for Surrogate Decision Makers of Patients With Prolonged Mechanical Ventilation (2019) · cites this paper as [38]
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Cites
Family Perspectives on End-of-Life Care at the Last Place of Care
Teno, J. M. (2004) · JAMA · doi:10.1001/jama.291.1.88 · Cited by 1,492 · see citing works
Relationship between cancer patients' predictions of prognosis and their treatment preferences
Weeks, J. C. (1998) · JAMA · doi:10.1001/jama.279.21.1709 · Cited by 1,319 · 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
Azoulay, E., Chevret, S., Leleu, G., Pochard, F., Barboteu, M., Adrie, C., Canoui, P., Le Gall, J. R., & Schlemmer, B. (2000) · Critical Care Medicine · doi:10.1097/00003246-200008000-00061 · Cited by 746 · 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 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
Fried, T. R., Bradley, E. H., & O'Leary, J. (2003) · Journal of the American Geriatrics Society · doi:10.1046/j.1532-5415.2003.51457.x · Cited by 301 · see citing works
Clinician predictions of intensive care unit mortality*
Rocker, G. M., Cook, D., Sjökvist, P., Weaver, B., Finfer, S. R., McDonald, E., Marshall, J. C., Kirby, A., Levy, M. M., Dodek, P., et al. (2004) · Critical Care Medicine · doi:10.1097/01.ccm.0000126402.51524.52 · Cited by 248 · see citing works
Cherlin, E. J., Fried, T. R., Prigerson, H. G., Schulman‐Green, D., Johnson‐Hürzeler, R., & Bradley, E. H. (2005) · Journal of Palliative Medicine · doi:10.1089/jpm.2005.8.1176 · Cited by 247 · see citing works
Surrogate Decision-Makers' Perspectives on Discussing Prognosis in the Face of Uncertainty
Evans, L. R., Boyd, E. A., Malvar, G. L., Apatira, L., Luce, J. M., Lo, B., & White, D. B. (2008) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200806-969oc · Cited by 236 · see citing works
Self-citationKruse, J. A. (1988) · JAMA · doi:10.1001/jama.1988.03410120085032 · Cited by 234 · see citing works
Complexities in Prognostication in Advanced Cancer
Lamont, E. B., & Christakis, N. A. (2003) · JAMA · doi:10.1001/jama.290.1.98 · Cited by 221 · see citing works
Family Satisfaction with End‐of‐Life Care in Seriously Ill Hospitalized Adults
Baker, R., Hyg, M., Wu, A. W., Teno, J. M., Kreling, B. A., Damiano, A. M., Rubin, H. R., Roach, M. J., Wenger, N. S., Phillips, R. S., et al. (2000) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2000.tb03143.x · Cited by 186 · see citing works
Decision‐Making and Outcomes of Prolonged ICU Stays in Seriously Ill Patients
Teno, J. M., Fisher, E., Hamel, M. B., Wu, A. W., Murphy, D. J., Wenger, N. S., Lynn, J., & Harrell, F. E. (2000) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2000.tb03144.x · Cited by 182 · 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-citationThe seriously ill hospitalized patient: Preferred role in end-of-life decision making?
Heyland, D. K., Tranmer, J. E., O'Callaghan, C. J., & Gafni, A. (2003) · Journal of Critical Care · doi:10.1053/jcrc.2003.yjcrc2 · Cited by 129 · see citing works
Discrepancies Between Patient and Physician Estimates for the Success of Stem Cell Transplantation
Lee, S. J. (2001) · JAMA · doi:10.1001/jama.285.8.1034 · Cited by 119 · see citing works
Communication of Prognostic Information for Critically Ill Patients
LeClaire, M. M., Oakes, J. M., & Weinert, C. (2005) · CHEST Journal · doi:10.1378/chest.128.3.1728 · Cited by 71 · see citing works
Jacobs, L. M. (2008) · Archives of Surgery · doi:10.1001/archsurg.143.8.730 · Cited by 64 · see citing works
Dawning of Awareness: The Experience of Surrogate Decision Making at the End of Life
Chambers‐Evans, J., & Carnevale, F. A. (2005) · The Journal of Clinical Ethics · doi:10.1086/jce200516104 · Cited by 54 · see citing works
William J. Sibbald: In Memoriam
Sprung, C. L., Martin, C. M., & Slutsky, A. S. (2006) · Critical Care Medicine · doi:10.1097/01.ccm.0000251822.45688.3c · Cited by 47 · see citing works
Flagged first, then by citations
Research works printed but not linked: 3
- [8]Christakis NA Death Foretold: Prophecy and Prognosis in Medical Care Chicago, IL The University of Chicago Press 1999
- [12]Anspach RR Deciding Who Lives: Fateful Choices in the Intensive Care Nursery Berkeley, CA University of California Press 1997
- [25]Rocker G Cook D Sjokvist P Level of care study investigators: Canadian critical care trials group Crit Care Med 2004 32 1149 1154 15190965
Cited by
Sorted by citations
Enzinger, A. C., Zhang, B., Schrag, D., & Prigerson, H. G. (2015) · Journal of Clinical Oncology · doi:10.1200/jco.2015.61.9239 · Cited by 379 · see citing works
Curtis, J. R., Nielsen, E. L., Treece, P. D., Downey, L., Dotolo, D., Shannon, S. E., Back, A. L., Rubenfeld, G. D., & Engelberg, R. A. (2011) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201006-1004oc · Cited by 269 · see citing works
Surrogate 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
“Given past research showing that few surrogates rely exclusively on physician prognostication when forming their perception of patient prognosis (38), it is also possible that the intervention simply received lower priority as an information source.”
Self-citation
- Authors
- Boyd, E. A., Lo, B., Evans, L. R., Malvar, G., Apatira, L., Luce, J. M., & White, D. B.
- Affiliations
- San Francisco General Hospital (US)
- Venue
- Critical Care Medicine
- Published
- 2010-05
- Volume
- 38
- Issue
- 5
- Pages
- 1270-1275
- ISSN
- 0090-3493 (ISSN-L)
- PMC
- PMC3530838
- OpenAlex
- W1999826877
- Cited by
- 190
- References
- 21
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 7 · 2023: 13 · 2022: 11 · 2021: 11 · 2020: 13 · 2019: 11 · 2018: 15 · 2017: 14 · 2016: 10 · 2015: 18 · 2014: 14 · 2013: 9 · 2012: 14
- FWCI
- 13.94
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Critical Care Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Center for Research Resources (KL2RR024130, K12RR023262)
- 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, seriously ill patients, intensive care unit patients, end-of-life decisions
- MeSH terms
- Adult, Age Factors, Aged, Decision Making, Female, Humans, Intensive Care Units, Interviews as Topic, Male, Middle Aged, Physician's Role, Professional-Family Relations, Prognosis, Religion, Critical Illness, Proxy
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