Factors Related to Discordance About Prognosis Between Physicians and Surrogate Decision Makers

A recent article by Douglas White and colleagues determined the prevalence and factors related to discordance about prognosis between physicians and surrogates who are making decisions for critically ill patients (JAMA. 2016;315(19):2086-2094. doi:10.1001/jama.2016.5351).  It is commonly thought that the misperceptions about prognosis by such surrogates is often attributed to poor comprehension of information.  Physician-surrogate discordance about prognosis occurred in 53% of the cases. Among the surrogates who had beliefs about the prognosis that were more optimistic than that of the physician, the most common reasons for optimism included:  1)a need to maintain hope to benefit the patient; 2) a belief that the patient had unique strengths unknown to the physician; and religious belief that only God knew when the patient would die. Knowledge of these factors might enhance communications during family meetings.