such as "Introduction", "Conclusion"..etc
January 1, 2009 -- Critically ill patients frequently have uncertain prognoses, but their families
overwhelmingly wish that physicians would address prognostic uncertainty
candidly, according to a new study out of the University of San Francisco
“Our interviews revealed that caregivers appear to
believe that some uncertainty is unavoidable, and just the nature of life,” said
lead author Douglas White, M.D., M.A.S., assistant professor in UCSF’s Division
of Pulmonary and Critical Care Medicine and the UCSF Program in Medical Ethics.
“The vast majority of families of critically ill patients want physicians to
openly discuss the prognosis, even when physicians can’t be certain that their
estimates are correct.”
But past research showing that physicians are
reluctant to discuss uncertain prognoses reveals a schism between families’
wishes and physicians’ comfort.
The results were reported in the second
issue for January of the American Journal of Respiratory and Critical Care
Medicine, published by the American Thoracic Society.
2006 and October 2007, researchers at the University of San Francisco Medical
Center conducted face-to-face interviews with 179 surrogate decision-makers for
patients in four separate intensive care units (ICUs). The interviews explored
surrogates’ attitudes about whether physicians should discuss prognoses when
they cannot be certain their prognostic estimates are correct.
asked whether they would prefer to hear physicians’ prognoses, 87 percent of
caregivers indicated that they would want to be told of all prognostic
estimates, even if the estimates were tentative. Most also indicated that they
appreciated a physician’s candor in discussing uncertain outcomes as honest,
rather than seeing it as a source of confusion or anxiety.
that family members wanted prognostic information in order to know whether they
needed to begin to prepare for the chance that their loved one might die, and so
begin the bereavement process,” Dr. White said. “I think one of the strongest
messages that comes from this study is that family members want to have this
discussion with the physician, and want to have the opportunity to take care of
unfinished personal and familial business before their loved one dies. They need
that chance to say their goodbyes, in case the patient does die.”
White also noted that while the majority of family members indicated that they
did want physicians to discuss all possible outcomes, a not-insignificant
portion— 12 percent— said they did not want to discuss uncertain prognoses,
indicating that a “one-size-fits-all” approach is insufficient in critical care
“Our findings suggest that physicians need to develop the
skills to understand the unique needs of surrogates, and then tailor their
approach to discussing prognosis to meet those needs,” he said. “This is an area
in need of well-designed quantitative and qualitative studies.”
and his colleagues are currently involved in a follow-up study to help family
members navigate the process of surrogate decision making in the ICU
John Heffner, M.D., past president of the ATS, emphasized that
the results of this study parallel previous investigations that examined patient
and family preferences in discussing do-not-resuscitate orders and end-of-life
care. “In almost all studies, patients and families express a desire for clear
information to inform their decisions. Although physicians often wish to shelter
their patients and patient families from what might seem to be harsh realities,
the human spirit is resilient. Patients and families access to information from
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