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"Hope, strength and faith"

Research study of families with a loved one in the ICU: families overestimated prognosis because of "hope, strength & faith."

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This fascinating research finding just popped up recently.

The researchers asked both the family members and the doctors to estimate the patients' chance of survival on a scale from 0 to 100. In more than half of the cases, there was a significant difference in predictions -- defined as a difference of at least 20 percent. The researchers found that the surrogates were typically more optimistic about a patient's chances, but the doctors' estimates were ultimately far more accurate.

The study authors also asked the family members to guess what the doctors answered. Generally, their guesses fell somewhere between their own estimates and the physicians' estimates, revealing that they understood they were being more optimistic than the doctors.

The researchers then interviewed the surrogates about why there was such a difference. In the majority of cases, there was an element of misunderstanding involved. However, more than half the time, even when the family members understood the prognosis they held different beliefs about the possible outcome.

The researchers asked the surrogates to discuss these beliefs. Three themes emerged: hope, strength and faith.

"The first and most common reason is that these family members believe that by holding a more optimistic belief about prognosis, that will actually help the patient have a better outcome," White explained. "This notion that hope will actually influence the patient's outcome arose in half the cases."

Another commonly held belief by family members was that the doctors didn't understand how strong their loved one really is and how substantial their will to live. "The families would say 'yeah, the doctor knows what happens to most people, but he doesn't know my mom and my mom is going to do better than the average patient,'" White said.

Finally, religion also played a role. "These families believed either a miracle would happen or they had other religiously grounded reasons for holding their prognostic estimate," White said.

Understanding the reasons for the differences in beliefs is important, experts say, because it can lead to better training for physicians in how to communicate with family members. They should not only focus on doing so in a clear manner, White said, but also take into consideration the emotional and psychological elements that can cause them to hold different expectations about the patients' chance of survival.

In an accompanying editorial, a group of doctors from Hôpital Saint-Louis in Paris and Memorial Sloan Kettering Cancer Center in New York City call these conversations "one of the most challenging tasks faced by intensivists [critical care specialists] and others providing care for critically ill patients."

What is a provocation or insight that might inspire others during this challenge?

Could these values -- hope, strength and faith -- somehow also help families (or patients) ACCEPT death rather than fight it? Could these be reframed?

Tell us about your work experience:

Internist at Stanford and widow -- my husband Paul died of lung cancer at 37 (he wrote the book When Breath Becomes Air after his diagnosis). xoxo


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