A Randomized Trial of Two Methods to Disclose Prognosis to Surrogate Decision Makers in Intensive Care Units

被引:82
作者
Char, Susan J. Lee [2 ]
Evans, Leah R. [3 ]
Malvar, Grace L. [4 ]
White, Douglas B. [1 ]
机构
[1] Univ Pittsburgh, Med Ctr, Dept Crit Care Med, Program Eth & Crit Care Med, Pittsburgh, PA 15261 USA
[2] Univ Calif San Francisco, Sch Med, Dept Surg, San Francisco, CA 94143 USA
[3] Boston Univ, Sch Med, Boston, MA 02118 USA
[4] Harvard Univ, Sch Med, Boston, MA USA
基金
美国国家卫生研究院;
关键词
surrogate decision making; risk communication; prognosis; withdrawing life-sustaining treatment; OF-LIFE CARE; FAMILY CONFERENCES; CANCER-PATIENTS; COMMUNICATION; PHYSICIAN; PROBABILITY; WORDS; TRUST; ICU; PROGNOSTICATION;
D O I
10.1164/rccm.201002-0262OC
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Rationale Surrogate decision makers and clinicians often have discordant perceptions about a patient's prognosis. There is a paucity of empirical data to guide communication about prognosis. Objectives: To assess: (1) whether numeric or qualitative statements more reliably convey prognostic estimates; and (2) whether surrogates believe physicians' prognostic estimates. Methods: A total of 169 surrogate decision makers for intensive care unit patients were randomized to view 1 of 2 versions of a video portraying a simulated family conference involving a hypothetical patient. The videos varied only by whether prognosis was conveyed in numeric terms ("10% chance of surviving") or qualitative terms ("very unlikely" to survive). Measurements and Main Results: We assessed: (1) surrogates' personal estimates of the patient's prognosis; and (2) surrogates' understanding of the physician's prognostic estimate. Neither surrogates' personal estimates nor their understanding of the physician's prognostication differed when prognosis was conveyed numerically versus qualitatively (surrogates' estimate, 22 +/- 23% chance of survival versus 26 +/- 24%, P = 0.26; understanding of physician's estimate, 17 +/- 22% chance of survival versus 16 +/- 17%, P = 0.62). One in five surrogates estimated the patient's prognosis was greater than 20% more optimistic than the physician's prognostication. Less trust in physicians was associated with larger discrepancies between surrogates' personal estimates and their understanding of the physician's estimate. Conclusions: Neither numeric nor qualitative statements reliably convey news of a poor prognosis to surrogates in intensive care units. Many surrogates do not view physicians' prognostications as absolutely accurate. Factors other than ineffective communication may contribute to physician-surrogate discordance about prognosis.
引用
收藏
页码:905 / 909
页数:5
相关论文
共 34 条
[1]  
APPELBAUM PS, 1982, ARCH GEN PSYCHIAT, V39, P951
[2]   Half the families of intensive care unit patients experience inadequate communication with physicians [J].
Azoulay, E ;
Chevret, S ;
Leleu, G ;
Pochard, F ;
Barboteu, M ;
Adrie, C ;
Canoui, P ;
Le Gall, JR ;
Schlemmer, B .
CRITICAL CARE MEDICINE, 2000, 28 (08) :3044-3049
[3]  
Berg JW., 2001, INFORM CONSENT LEGAL, VSecond, DOI 10.1093/oso/9780195126778.003.0023
[4]  
BRYANT GD, 1980, NEW ENGL J MED, V302, P411
[5]   Physician-patient relationship in the intensive care unit: Erosion of the sacred trust? [J].
Chaitin, E ;
Stiller, R ;
Jacobs, S ;
Hershl, J ;
Grogen, T ;
Weinberg, J .
CRITICAL CARE MEDICINE, 2003, 31 (05) :S367-S372
[6]   ADVERBS AS MULTIPLIERS [J].
CLIFF, N .
PSYCHOLOGICAL REVIEW, 1959, 66 (01) :27-44
[7]   Expectations and outcomes of prolonged mechanical ventilation [J].
Cox, Christopher E. ;
Martinu, Tereza ;
Sathy, Shailaja J. ;
Clay, Alison S. ;
Chia, Jessica ;
Gray, Alice L. ;
Olsen, Maren K. ;
Govert, Joseph A. ;
Carson, Shannon S. ;
Tulsky, James A. .
CRITICAL CARE MEDICINE, 2009, 37 (11) :2888-2894
[8]   Missed opportunities during family conferences about end-of-life care in the intensive care unit [J].
Curtis, JR ;
Engelberg, RA ;
Wenrich, MD ;
Shannon, SE ;
Treece, PD ;
Rubenfeld, GD .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2005, 171 (08) :844-849
[9]   The family conference as a focus to improve communication about end-of-life care in the intensive care unit: Opportunities for improvement [J].
Curtis, JR ;
Patrick, DL ;
Shannon, SE ;
Treece, PD ;
Engelberg, RA ;
Rubenfeld, GD .
CRITICAL CARE MEDICINE, 2001, 29 (02) :N26-N33
[10]  
Curtis JR, 2001, J GEN INTERN MED, V16, P41