Shared Decision-Making Communication and Prognostic Misunderstanding in the ICU
Surrogates often make decisions on behalf of critically ill patients.1 Surrogate comprehension of patient survival prognosis can affect these decisions: surrogate prognostic estimates of survival that are overly optimistic compared with clinician estimates are associated with increased use of life-sustaining treatments and reduced quality of life for dying patients.2,3 … Different prognostic estimates by surrogates and clinicians, or prognostic discordance, may come from 2 sources: (1) surrogate misunderstanding the clinician’s prognostic estimates and (2) surrogate disagreement with the clinician’s prognostic estimate.
Led by Judith Vick (formerly of Duke, now at Yale), we found that there was lots of misunderstanding going on, but less of it after family meetings. Here is a picture:
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