Even when told that death is likely, families of intensive care patients tend to be overly optimistic about the possibility of recovery, a new study finds.
Because they often have to make treatment decisions for patients too ill to express their own wishes, it's important for family members to have a clear understanding of their loved one's prognosis, said Dr. Douglas White, an associate professor in the department of critical care medicine at the University of Pittsburgh School of Medicine.
"Research has shown us that prognostic information influences treatment decisions near the end of life," White said. "But there's evidence of disconnect between what the doctor says and how the surrogates interpret the meaning."
The study, which appears in the Annals of Internal Medicine, included 80 surrogate decision makers at three ICUs in San Francisco who read statements such as "He will definitely survive," "He has a 90% chance of surviving," "He has a 5% chance of surviving," and "He will definitely not survive."
Keeping positive despite the odds
The participants, who were told that the statements were hypothetical and not related to their own loved one's prognosis, were asked to interpret the statements about the patients' chances of survival.
The participants accurately assessed the survival odds when a patient's prognosis was generally good, but that was not the case with poor prognoses. Forty percent of participants were overly optimistic in their interpretation of a 50% survival chance, and nearly two-thirds were too optimistic in their interpretation of a 5% survival chance.
When the participants were asked to explain their overly optimistic interpretations, their responses included statements such as, "I hold on to hope strongly," "There is still hope," and "[The doctors] are not giving you a real figure."
"Our research indicates that in the ICU setting, family members want to see the glass as half full, even if it's really nearly empty," White said. "They accurately interpreted statements conveying good prognoses, which means it's not a simple misunderstanding of numbers that explains their misperceptions. Instead, they appear to be biased to optimism as a coping strategy to deal with the highly stressful situation of having a loved one near death."
ICU death rate higher at weekends
The Society of Critical Care Medicine has more about making decisions for ICU patients.
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