ArticleCritical care medicine2019
A Multicenter Study of the Causes and Consequences of Optimistic Expectations About Prognosis by Surrogate Decision-Makers in ICUs.
Article in Critical care medicine, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
15 citing papers in PubMed, 1 synthesis or guideline pooled it, 41 citations in OpenAlex.
- Clinical Predictive Models of Sudden Cardiac Arrest: A Survey of the Current Science and Analysis of Model Performances.Journal of the American Heart Association · 2020Pooled it
- Randomized Clinical Trial of the Four Supports Intervention for Surrogate Decision-Makers in Intensive Care Units.American journal of respiratory and critical care medicine · 2025Trial
- The Effect of Disclosing Life Expectancy Information on Patients' Prognostic Understanding: Secondary Outcomes From a Multicenter Randomized Trial of a Palliative Chemotherapy Educational Intervention.Journal of pain and symptom management · 2021Trial
- Effect of Intensivist Communication in a Simulated Setting on Interpretation of Prognosis Among Family Members of Patients at High Risk of Intensive Care Unit Admission: A Randomized Trial.JAMA network open · 2020Trial
- The impact of life orientation on advance care planning engagement in surrogate decision-makers of terminal cancer patients: a chain mediation model of social support and uncertainty of disease.BMC palliative care · 2025Article
- Time-Limited Trials in Intensive Care Medicine: A Tool for Avoiding Inappropriate Treatment.Deutsches Arzteblatt international · 2025Review
- Clinicians' Use of Choice Framing in ICU Family Meetings.Critical care medicine · 2024Article
- Shared Decision-Making Communication and Prognostic Misunderstanding in the ICU.JAMA network open · 2024Article
- Accuracy of Expected Symptoms and Subsequent Quality of Life Measures Among Adults With COPD.JAMA network open · 2023Article
- Critically ill patient mortality by age: long-term follow-up (CIMbA-LT).Annals of intensive care · 2023Article
- Effect of Hospital Linens on Unit-Acquired Pressure Injuries for Adults in Medical ICUs: A Cluster Randomized Controlled Trial.Critical care explorations · 2021Article
- Optimism bias in understanding neonatal prognoses.Journal of perinatology : official journal of the California Perinatal Association · 2021Article
- Palliative Care Principles and Anesthesiology Clinical Practice: Current Perspectives.Journal of multidisciplinary healthcare · 2021Review
- Dealing with "Difficult" Patients and Families: Making a Case for Trauma-informed Care in the Intensive Care Unit.Annals of the American Thoracic Society · 2020Article
- Use of the Serious Illness Conversation Guide to Improve Communication with Surrogates of Critically Ill Patients. A Pilot Study.ATS scholar · 2020Article
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Authors and funding
17 authors at 4 institutions in 1 country.
Funding
Abstract
objectivesOptimistic expectations about prognosis by surrogate decision-makers in ICUs are common, but there are few data about the causes and clinical consequences. Our objective was to determine the causes of optimistic expectations about prognosis among surrogates and whether it is associated with more use of life support at the end of life.
designProspective, multicenter cohort study from 2009 to 2012.
settingTwelve ICUs from multiple regions of the United States. SUBJECTS: The surrogates and physicians of 275 incapacitated ICU patients at high risk of death.
interventionsNone. MEASUREMENTS AND MAIN
resultsSurrogates and physicians completed a validated instrument assessing their prognostic expectations for hospital survival. We determined the proportion of surrogates with optimistic expectations, defined as a prognostic estimate that was at least 20% more optimistic than the physician's, then determined how frequently this arose from surrogates miscomprehending the physicians' prognosis versus holding more hopeful beliefs compared with the physician. We used multivariable regression to examine whether optimistic expectations were associated with length of stay, stratified by survival status, and time to withdrawal of life support among nonsurvivors. Overall, 45% of surrogates (95% CI, 38-51%) held optimistic expectations about prognosis, which arose from a combination of misunderstanding the physician's prognostic expectations and from holding more hopeful beliefs compared with the physician. Optimistic expectations by surrogates were associated with significantly longer duration of ICU treatment among nonsurvivors before death (β coefficient = 0.44; 95% CI, 0.05-0.83; p = 0.027), corresponding to a 56% longer ICU stay. This difference was associated with a significantly longer time to withdrawal of life support among dying patients whose surrogates had optimistic prognostic expectations compared with those who did not (β coefficient = 0.61; 95% CI, 0.16-1.07; p = 0.009).
conclusionsThe prevalent optimism about prognosis among surrogates in ICUs arises both from surrogates' miscomprehension of physicians' prognostications and from surrogates holding more hopeful beliefs. This optimism is associated with longer duration of life support at the end of life.
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