Study examines how optimism shapes medical decisions
Doctors know that friends and family members tend to be more optimistic about a sick patient's chances of survival than doctors, and a study published Tuesday offers a deeper look at what's behind the optimism.
Among study participants who were more optimistic than doctors about a loved one's chances, many said they thought a positive attitude could improve the patient's chance of survival, according to results published by the Journal of the American Medical Association. Others told researchers they felt the patient had strength the doctor didn't know about; and a third group reported their optimism was rooted in religious belief.
“It changes how physicians should respond to this in clinical practice,” Dr. Douglas White, the study's lead author and a University of Pittsburgh School of Medicine professor, said of the study.
Differences in expectation between doctors and those who make medical decisions for incapacitated patients are often attributed to decision-makers not understanding medical information, White said. Understanding that more factors are at play could help doctors communicate better with people making difficult medical decisions, he said.
Researchers over five years surveyed 229 surrogate decision-makers — those in charge of making decisions for critically ill patients — along with the patients' doctors in intensive care units at the University of California, San Francisco, where White used to be a faculty member.
Surrogates and doctors held different beliefs about patients' prognoses in 122 instances, the study found. Ninety-eight surrogates were more optimistic than doctors, and 24 were more pessimistic. Seventy-one surrogates with more optimistic beliefs than doctors agreed to follow-up interviews.
Among those, 34 said they stayed optimistic because they felt maintaining hope would benefit the patient; 24 because they felt the patient had strengths unknown to the doctor; and 19 because of religious beliefs.
“Broadly speaking, it speaks to the need for physicians to have empathic, clear conversations about prognosis,” White said.
A surrogate's opinion about a patient's chance of survival can affect when the patient moves to palliative care. Continuing attempts to prolong life can make the end more unpleasant, White said.
Doctors should check whether family members understand their medical assessments, a step he said research shows doctors rarely take. If doctors find that views differ, the doctor shouldn't assume the difference is a result of misunderstanding, he said.
Doctors often struggle between providing a realistic prognosis and avoiding the perception that they are giving up on a patient, said Dr. Arvind Venkat, an emergency physician and chairman of the Ethics Committee at Allegheny General Hospital. Venkat was not involved in the study.
“I think it's far better to be empathetic but straightforward about what the medical science says about the patient versus trying to give a false sense of what the medical science says about prognosis,” Venkat said. “But that doesn't mean we should ever give the sense that we're giving up on a patient.”
Studies have shown palliative care is much better than standard critical care at treating symptoms such as pain, he said. And in some cases, palliative care extends life longer than attempts to cure the illness, he said.
Doctors should work to understand patients' religious and cultural backgrounds, he said.
“We need to be communicative with patients and family members in their language, not in our language,” he said.
UPMC and Allegheny Health Network are focusing on increasing communication between medical teams and patients after admission and during their stays, the doctors said.
Wes Venteicher is a Tribune-Review staff writer. Reach him at 412-380-5676 or firstname.lastname@example.org.