Factors Influencing Physician Prognosis: A Scoping Review

Abstract

Introduction. Prognosis is an essential component of informed consent for medical decision making. Research shows that physicians display discrepancies in their prognostication, leading to variable, inaccurate, optimistic, or pessimistic prognosis. Factors driving these discrepancies and the supporting evidence have not been reviewed systematically. Methods. We undertook a scoping review to explore the literature on the factors leading to discrepancies in medical prognosis. We searched Medline (Ovid) and Embase (Ovid) databases for peer-reviewed articles from 1970 to 2017. We included articles that discussed prognosis variation or discrepancy and where factors influencing prognosis were evaluated. We extracted data outlining the participants, methodology, and prognosis discrepancy information and measured factors influencing prognosis. Results. Of 4,723 articles, 73 were included in the final analysis. There was significant variability in research methodologies. Most articles showed that physicians were pessimistic regarding patient outcomes, particularly in early trainees and acute care specialties. Accuracy rates were similar across all time periods. Factors influencing prognosis were clustered in 4 categories: patient-related factors (such as age, gender, race, diagnosis), physician-related factors (such as age, race, gender, specialty, training and experience, attitudes and values), clinical situation-related factors (such as physician-patient relationship, patient location, and clinical context), and environmental-related factors (such as country or hospital size). Discussion. Obtaining accurate prognostic information is one of the highest priorities for seriously ill patients. The literature shows trends toward pessimism, especially in early trainees and acute care specialties. While some factors may prove difficult to change, the physician’s personality and psychology influence prognosis accuracy and could be tackled using debiasing strategies. Exposure to long-term patient outcomes and a multidisciplinary practice setting are environmental debiasing strategies that may warrant further research. Highlights Literature on discrepancies in physician’s prognostication is heterogeneous and sparse. Literature shows that physicians are mostly pessimistic regarding patient outcomes. Literature shows that a physician’s personality and psychology influence prognostic accuracy and could be improved with evidence-based debiasing strategies. Medical specialty strongly influences prognosis, with specialties exposed to acutely ill patients being more pessimistic, whereas specialties following patients longitudinally being more optimistic. Physicians early in their training were more pessimist than more experienced physicians.

Doctors and nurses subjective predictions of 6-month outcome compared to actual 6-month outcome for adult patients with spontaneous intracerebral haemorrhage (ICH) in neurocritical care: An observational study

“…Recognising patterns of disease, experience, intuitive judgement and ‘rule of thumb’ applications are all part of heuristic decision making [ 37 , 38 ]. Doctors with less experience and working in acute settings tend to be more pessimistic [ 18 ] and therefore may be more prone to clinical nihilism. A standardised approach to prognostication is needed to guide those with less experience and to limit bias [ 36 ].…”

“…A standardised approach to prognostication is needed to guide those with less experience and to limit bias [ 36 ]. Exposure to long-term patient outcomes and a multidisciplinary environment are recommended as debiasing strategies [ 18 ].…”

“…However, specific clinical, radiological and patient demographics associated with death after ICH such as decreasing GCS score (≤ 8) and/or a high National Institutes of Health Stroke Scale (NIHSS) score, high illness severity scores, ICH volume and presence and amount of intraventricular haemorrhage [ 24 , 25 ] were not included in this study. Furthermore, subjective factors that doctors' and nurses incorporate into their early subjective predictions of ICH outcome, such as psychosocial aspects of care, religious, cultural or ethnic background, as well as clinicians' personality and psychology [ 18 ] may also influence prognosis accuracy and warrants further research.…”

“…There is evidence that bedside clinicians' clinical judgement may be superior to prediction model estimates of ICH prognosis [ 15 , 16 ], although other data suggest variation with potential for both optimism and pessimism [ 17 ]. Some studies suggest that doctors might be pessimistic regarding their prognosis, especially for those training in acute care specialities [ 18 ]. Variability in clinician prognosis has implications for ICH patient care including variability in treatment and thus outcome.…”

A Virtual Case Presentation Platform: Protocol Study

“…After that, the student describes the possible complications that may appear during the illness/treatment, and he/she defines a prognosis that contains the prediction of the patient’s disease trajectory/evolution [ 10 ].…”