Family members tend to be overly optimistic about the prognosis of a patient in a hospital’s intensive care unit, even after being told recovery is not likely, new research shows.
The study, by researchers at the University of Pittsburgh School of Medicine, found many family members try to sustain hope and belief that their loved one will defy medical odds.
Researchers, writing in the Annals of Internal Medicine, said the findings highlight the need for family members to have a clearer understanding of a patient’s prognosis --particularly in cases where a relative is designated to act as a surrogate decision-maker for a person too ill to communicate his or her own wishes.
"Research has shown us that prognostic information influences treatment decisions near the end of life," said Dr. Douglas B. White a critical-care specialist at the University of Pittsburgh. "But there's evidence of disconnect between what the doctor says and how the surrogates interpret the meaning."
For the study, the team surveyed 80 surrogate decision-makers about hypothetical patient cases at three ICUs in San Francisco. The participants read statements such as "He will definitely survive," "He has a 90 percent chance of surviving," "He has a 5 percent chance of surviving," and "He will definitely not survive." Surrogates then noted their interpretation of the survival odds on a scale of 0 to 100 percent.
The researchers found that participants accurately interpreted statements when the prognosis was good. But that was not the case with poor prognoses; 40 percent of surrogates interpreted the 50 percent survival chance more optimistically than warranted, and nearly two-thirds interpreted a 5 percent survival chance more optimistically.
When asked to explain overly optimistic expectations, participants tended to say they “hold onto hope strongly" or "They're 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 noted. "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."
The study was partly funded by the National Heart, Lung, and Blood Institute, part of the National Institutes of Health.