Navigation Links
Family members of critically ill patients want to discuss loved ones' uncertain prognoses

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 Medical Center.

"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.

Between January 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.

When 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.

"We learned 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."

Dr. 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 situations.

"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."

Dr. White 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 setting.

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 their doctors."


Contact: Keely Savoie
American Thoracic Society

Related medicine news :

1. Family rejection of LGB children linked to poor health in early childhood
2. Beta Release of a New Genetics Website-
3. New Easter Seals-MassMutual Study: Autism Strains Family Finances, Threatens Long-Term Care and Security
4. Obesity is a Family Affair
5. AT&T Supports the Smith Familys Learning For Life Program
6. Ten Ways You Can Help a Family During the Holidays After a Child Dies
7. Provides Parents With Sense of Relief
8. Siskin Center for Child and Family Research to Focus on Early Childhood Development and Special Education
9. LegalView Updates Brain Injury Site with Information on TBI Disabled Soldier's Family
10. Almost Family Announces Acquisition of Kentucky Home Health Certificate of Need
11. Kaiser Family Foundation Partners With Media Around The Globe to Address HIV/AIDS
Post Your Comments:
(Date:11/25/2015)... ... November 25, 2015 , ... Castlewood Treatment Center for ... eating disorders as a result of the $20,000 raised at the center’s recent ... Run Golf Club in Eureka, will help individuals who otherwise might not seek ...
(Date:11/25/2015)... ... ... Many people know of the common symptoms of low thyroid hormone (also ... many people who find their cholesterol levels and weight are creeping up are more ... they don’t have any of the other symptoms. , Thyroid hormone plays a major ...
(Date:11/24/2015)... ... November 25, 2015 , ... Genesis Chiropractic Software helps practice ... an agreement between the practice owner and the patient that automatically manages all ... projections. Click here to learn more. , According to ...
(Date:11/24/2015)... , ... November 24, 2015 , ... Charitable giving is ... donations are made in the last five weeks of the year totalling over $358 ... in 2012 to connect the nation’s charities with those individuals who want to “give ...
(Date:11/24/2015)... ... 2015 , ... The hospitals and health systems on this ... care. They have received recognition for excellence from various reputable organizations in areas ... Hospital Review selected hospitals for inclusion based on national rankings and awards from ...
Breaking Medicine News(10 mins):
(Date:11/24/2015)... Nueva York , 24 de noviembre de ... del Avery Breathing Pacemaker System, se complace anunciar ... Ph.D. como consultor clínico. ... Foto -   ... Jonzon es un fisiólogo y consultor en neonatología ...
(Date:11/24/2015)... NEWS, Va. , Nov. 24, 2015  DILON ... they have signed an agreement for DILON to distribute ... geographies across the globe. The signing of this distribution agreement ... Discovery NM750b Molecular Breast Imaging system and is considered ... to provide better healthcare solutions for clinicians and their ...
(Date:11/24/2015)... 24, 2015 Sectra (STO: SECT ... entered into a multi-year agreement to deploy Breast ... will provide the Breast Center a future-proof platform capable ... (STO: SECT B) announces that Breast Center of Acadiana ... Breast Imaging PACS in its two freestanding imaging centers. ...
Breaking Medicine Technology: