it’s not just what the doctor tells me …

May 21, 2011

in Bioethics,Hospice & Palliative Medicine,Journal Club

… factors that influence decision makers’ perceptions of prognosis … Boyd et al sought to determine what sources of knowledge family members/decision makers use when determining the prognosis of their loved ones.

“Less than 2% (3 of 179) of surrogates reported that their beliefs about the patients’ prognoses hinged exclusively on prognostic information provided to them by physicians. The majority cited other factors in addition to physicians’ predictions that also contributed to their beliefs about the patients’ prognoses, including perceptions of the patient’s individual strength of character and will to live; the patient’s unique history of illness and survival; the surrogate’s own observations of the patient’s physical appearance; the surrogate’s belief that their presence at the bedside may improve the prognosis; and the surrogate’s optimism, intuition, and faith.”

The authors conclude that “both parties [doctors and decision makers] have important insight and expertise to add to a richer understanding of the patient. We propose that the goal should be to view prognostication not as a unidirectional transmission of knowledge but rather a bidirectional discussion aimed at achieving a shared understanding of not only the patient’s physical condition but also the unique life experience and personal characteristics that many surrogates view as relevant to predicting the patient’s future.”

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