Surrogates Tend to Misinterpret Poor Prognosis Information

Statements about low risk of death interpreted accurately; poor prognosis viewed optimistically

FRIDAY, March 9 (HealthDay News) -- Surrogate decision makers for critically ill patients interpret prognostic statements expressing a low risk of death accurately, but interpret statements conveying poor prognosis optimistically, according to a study published in the March 6 issue of the Annals of Internal Medicine.

Lucas S. Zier, M.D., from the University of California in San Francisco, and colleagues investigated how 80 decision-making surrogates for critically ill patients in three hospitals interpreted prognostic statements and looked at the factors that influence interpretation of poor prognostic information. Fifteen surrogates who interpreted statements more optimistically as the probability of survival decreased participated in a semistructured interview.

The researchers found that interpretations were generally accurate for prognostic statements expressing a low risk of death, but were more optimistic than the actual meaning for statements conveying a high risk of death. Interpretation of the statement "90 percent chance of surviving" was accurate, whereas interpretations of "5 percent chance of survival" were more optimistic and showed considerable variability. This trend was explained by surrogates' need to register optimism in the face of a poor prognosis and their belief that patient attributes would contribute to better-than-predicted outcomes.

"Inaccurate interpretations of physicians' prognostications by surrogates arise partly from optimistic biases rather than simply from misunderstandings," the authors write.

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