Decision-makers for critically ill patients tend to be overly optimistic about the prognosis of a condition, a new study has found.

Specifically, more than 50 percent of family members and friends who make decisions for patients with serious medical conditions have notable differences in estimated prognosis than their doctor.

The significant discrepancies in the perception of decision-makers and doctors do not solely rely on mere misunderstanding. Sometimes, family and friends really hold very different and overly optimistic basic beliefs as regards patient outcomes. Such concept may help doctors better communicate with their patients' relatives and friends so that they can arrive at the best decision for their loved one.

"It isn't a bad thing for a patient's family and friends to have hope that they will recover," says study lead author Douglas B. White from the University of Pittsburgh. He adds, however, that it becomes tricky when those overly optimistic beliefs lead to more radical treatments for dying patients, when they can already start receiving appropriate palliative care to decrease suffering.

The Study

White and colleagues conducted a study involving 229 individuals, who acted as "surrogate decision-makers" for critically ill patients admitted at University of California's San Francisco Medical Center.

The surrogate participants were commonly friends and relatives of the patient. Through the process, they also looked into the caring qualities of the doctors for their patient.

The team then asked the surrogates and the physicians to assess the chances the patient would be able to survive from hospital admission. Both groups were asked to give a rating between zero to 100, with the former indicating no chance of survival and 100, definite survival. Both groups did not know the answers of the other.

The findings showed that there was a 20 percent discrepancy in answers among 53 percent of the total cases. Specifically, the surrogates were typically more optimistic than physicians, who, interestingly, were found to have more accurate answers.

Surrogates Aware Of Over-Optimism

When asked about what they think of the doctors' answers, the surrogates were able to guess ratings in between their own estimates and those of the doctors. This means the surrogates are aware that they hold more optimistic views than the reports the doctors communicate to them.

The overly optimistic beliefs of the surrogates are rooted from a variety of things. First, they believe that if they maintain hope, the patients would progress better than what doctors anticipate. Also, they think that they know the patients better than the doctors and that the patient has traits and strengths that the doctors do not know. Lastly, their optimistic views are often guided by religious beliefs.

White explains that doctors truly want to give the best care for their patients. For critically ill patients, this means being able to communicate better with family and friends, who act as decision-makers.

The study pushed the team to work on strategies that could enhance understanding of surrogates about doctors' prognosis reports and to attend better to emotional and psychological factors that may drive surrogates' expectations.

The study was published in The Journal of the American Medical Association on May 17.

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