Attitude and Self-reported Practice Regarding Prognostication in a National Sample of Internists

Christakis, Nicholas A.; Iwashyna, Theodore J.

doi:10.1001/archinte.158.21.2389

Cited by 402 publications

(321 citation statements)

References 36 publications

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“…We found just one participant in our study who had previously discussed prognosis with their doctor, consistent with the contention that clinicians share prognosis less often than their patients would prefer. 29,[36][37][38] Participant perspectives in our study also supported those who have argued for clinician-initiated discussions of prognosis that are highly personalized, 17 empathic, 30 and begin with the explicit determination of each patient's preferences for discussion. 29 As evidence of the deeply personal nature of patient preferences for prognostic information, we noted that many patients viewed prognosis as uncertain, yet some saw this as a reason to avoid prognostic information, while others preferred that clinicians simply acknowledge uncertainty in their prognostic discussions (final quotes, Tables 2 and 3).…”

Section: Resultssupporting

confidence: 76%

“Knowing is Better”: Preferences of Diverse Older Adults for Discussing Prognosis

et al. 2011

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Section: Resultssupporting

confidence: 76%

“Knowing is Better”: Preferences of Diverse Older Adults for Discussing Prognosis

et al. 2011

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“…26 However, these results are more in line with reports of providers working in specialized settings such as the intensive care unit (ICU), where predictions may be more accurate. 27,28 It is noteworthy, though, that the hospice nurses in this study were subject to the same optimism bias that has been described elsewhere for physicians 24,25 and that they consistently underestimated 7-day mortality.…”

Section: Discussionsupporting

confidence: 55%

“…This is unexpected because previous studies have found that health care providers are poor at predicting prognosis, 24,25 and even palliative care providers tend to be optimistic. 26 However, these results are more in line with reports of providers working in specialized settings such as the intensive care unit (ICU), where predictions may be more accurate.…”

Section: Discussionmentioning

confidence: 87%

The Art versus Science of Predicting Prognosis: Can a Prognostic Index Predict Short-Term Mortality Better than Experienced Nurses Do?

Casarett

Farrington²,

Craig³

et al. 2012

Journal of Palliative Medicine

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Objective: To determine whether a prognostic index could predict one-week mortality more accurately than hospice nurses can. Method: An electronic health record-based retrospective cohort study of 21,074 hospice patients was conducted in three hospice programs in the Southeast, Northeast, and Midwest United States. Model development used logistic regression with bootstrapped confidence intervals and multiple imputation to account for missing data. The main outcome measure was mortality within 7 days of hospice enrollment. Results: A total of 21,074 patients were admitted to hospice between October 1, 2008 and May 31, 2011, and 5562 (26.4%) died within 7 days. An optimal predictive model included the Palliative Performance Scale (PPS) score, admission from a hospital, and gender. The model had a c-statistic of 0.86 in the training sample and 0.84 in the validation sample, which was greater than that of nurses' predictions (0.72). The index's performance was best for patients with pulmonary disease (0.89) and worst for patients with cancer and dementia (both 0.80). The index's predictions of mortality rates in each index category were within 5.0% of actual rates, whereas nurses underestimated mortality by up to 18.9%. Using the optimal index threshold ( < 3), the index's predictions had a better c-statistic (0.78 versus 0.72) and higher sensitivity (74.4% versus 47.8%) than did nurses' predictions but a lower specificity (80.6% versus 95.1%). Conclusions: Although nurses can often identify patients who will die within 7 days, a simple model based on available clinical information offers improved accuracy and could help to identify those patients who are at high risk for short-term mortality.

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“…16,17 In doing so, we touched on a subject that even many physicians prefer not to address due to concerns about causing parents distress. [18][19][20][21] We therefore evaluated parents' experiences as study participants.…”

Section: Introductionmentioning

confidence: 99%

Research Participation Experiences of Parents of Children with Cancer Who Were Asked about their Child's Prognosis

Olcese

Mack²

2012

Journal of Palliative Medicine

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Background: In questionnaire-based research, human subject protection committees must assess the emotional impact of the study on participants. Without clear data about the risks and benefits of participating in such studies, however, review board members must use personal judgment to assess emotional harm. Objective: To examine experiences of distress and value of participation in a study of prognosis communication among parents of children with cancer, and to identify factors associated with predominantly distressing research experiences. Methods: We surveyed 194 parents of children with cancer (overall response rate, 70%), treated at the DanaFarber Cancer Institute and Children's Hospital, Boston, Mass, in the first year after the child's cancer diagnosis. The survey focused on the child's prognosis and parent-physician communication; at the end, we asked parents how distressing and how useful completing the survey had been to them personally. Results: Only 1% of parents found research participation to be ''very'' distressing. The majority of parents were ''not at all'' distressed by participating (62%), and most reported that the questionnaire was at least ''a little'' useful to them personally (69%). Overall, 18% of parents gave higher ratings for distress than for utility. Parents were more likely to experience research participation as predominantly distressing when they found prognostic information to be upsetting (odds ratio [OR] 5.38, p = 0.005).

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Attitude and Self-reported Practice Regarding Prognostication in a National Sample of Internists

Abstract: Background: Since prognostication appears increasingly important in clinical practice, especially in end-oflife care, we examined physicians' experiences and attitudes regarding it.

Cited by 402 publications

References 36 publications

“Knowing is Better”: Preferences of Diverse Older Adults for Discussing Prognosis

“Knowing is Better”: Preferences of Diverse Older Adults for Discussing Prognosis

The Art versus Science of Predicting Prognosis: Can a Prognostic Index Predict Short-Term Mortality Better than Experienced Nurses Do?

Research Participation Experiences of Parents of Children with Cancer Who Were Asked about their Child's Prognosis

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