Surrogates for incapacitated patients in intensive care units must
evaluate proposed medical interventions in the light of the patient’s values and
wishes. For this reason, it’s important
that surrogates, typically a spouse or a child, understand the prognosis for
their loved ones. A recent article in The
Annals of Internal Medicine by Lucas S. Zier and colleagues, “Surrogate
decision makers’ interpretation of prognostic information,” suggests that
decision makers interpret the prognosis differently according to its
favorability for the patient's survival (http://www.annals,org/content/156/5/360.abstract).
Over a three-year period, 80 surrogates for critically ill patients in an
intensive care unit at a San Francisco hospital were asked to interpret 16
prognostic statements for hypothetical patients, unrelated to their loved ones. For example, “If a doctor says ‘He will
definitely survive,’ what does that mean to you?” Participants were asked to place a mark on a
probability scale corresponding to the patient’s probability of survival from
“Will survive (100% chance of survival)” to “Will not survive (0% chance of
survival).” Respondents whose answers
varied markedly from the prognosis were individually interviewed.
The researchers found that the respondents interpreted favorable
prognoses correctly but that their interpretation of negative prognoses (5% to
50% chance of survival) tended to be more optimistic than warranted by the
prognosis. Interviewees explained these
discrepancies in terms of the need to be positive and the reluctance to take at
face value doctors’ predictions, since these are sometimes wrong.
Naturally, I wondered how patients themselves view such prognoses. My
guess is that they give a more favorable
interpretation to negative predictions of their own survival.
Given a 5% chance of survival, many patients probably figure that they’ll
be among that 5%. Somebody has to be,
after all. A friend of mine, for
example, has survived with pancreatic cancer for more than five years, when
fewer than 5% live that long with the disease.
As for myself, I hope I’ll greet a negative prognosis, when it comes,
realistically. I know that I harbor a
terminal disease. The only question is
whether that or something else will carry me off. I won’t want aggressive treatments when the
likelihood of surviving them is low and when the extra months of life that they
provide are likely to be few. That’s how
I feel now. I hope I’ll still feel that
way when the time comes.
2010-2012 Anchises-An Old Man’s Journal All Rights Reserved
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