STATES CHRONICLE – Critically ill patients’ surrogates seem to have different expectations for their loved ones compared to the expectations the physicians have.
We have all been there or sadly we will all someday be in in a situation when a doctor talks to us about our critically ill loved one’s diagnosis. And in those moments, the doctor’s words might come off to us different than they really are. They’re usually confusing and misunderstood, when all we have is fear and all we want is hope.
A study published Thursday in JAMA took a look at the differences between surrogates and physicians regarding a critically ill patient’s expectations.
The study is titled “Prevalence of and Factors Related to Discordance about Prognosis between Physicians and Surrogate Decision Makers of Critically Ill Patients” and it used surveys and structured interviewing techniques to explore these differences.
In more than half of the studied cases, the surrogates of the critically ill patient disagreed with the physician that their loved one will ever leave the hospital given the right treatment. In 103 out of 229 cases, the surrogates misunderstood the doctor’s belief.
In almost 46 percent of the cases, the surrogates held a much more optimistic belief about the patient’s chances of leaving the hospital alive. As an explanation for this optimism, the interviewed acknowledged clinging to hope and their love one’s fighting spirit and will to live.
Many believe that “staying positive” would improve the patient’s chances.
These findings underscore the frequent situations in which faced with imminent death surrogate demand futile treatment or aggressive methods to have their loved ones saved. Sometimes these methods work, and sometimes they make a critically ill patient’s last hours very stressful and painful.
Had it not been for confusion and clouded judgment, a peaceful death might have come less upsetting for their loved one.
Family members and friends are biased towards diagnosis and prognosis, said the authors. Their mechanism of trying to grasp and deal with the possible loss of a loved one not only impairs the ability to understand the reality of things but it also might make the situation worse for the patient.
The study is trying to help prevent these cases. They encourage doctors to start with the question: “What is your understanding of what the clinical team expects to happen?”
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