Hope and Optimism May Cloud Judgment in ICUs

WEDNESDAY, March 7 (HealthDay News) —
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 in a university news release.
“But there’s evidence of disconnect between what the doctor says and how
the surrogates interpret the meaning.”

The study, which appears in the March 6 issue of 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 percent chance of surviving,” “He has a 5 percent chance of
surviving,” and “He will definitely not survive.”

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 percent survival chance, and nearly two-thirds were
too optimistic in their interpretation of a 5 percent 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.”

More information

The Society of Critical Care Medicine has more about making decisions for ICU patients.

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