Doctors are often reluctant to discuss a seriously ill patients' uncertain prognosis with family members, but recent research suggests that most families want doctors to address the patients' uncertain outlook openly and candidly. Researchers from America interviewed 179 family members of 142 seriously ill hospitalised patients who were at high risk of dying. The researchers explored the families' feelings about whether doctors should discuss prognoses when they cannot be certain their prognostic estimates are right. The results suggest that most family members accept prognostic uncertainty as 'unavoidable and acceptable' and 87 percent of those interviewed indicated that they would want to be told of all prognostic estimates, even if the estimates were tentative. It was found that most family members appreciated a physician's candor in honestly discussing uncertain outcomes for their loved one; in general, they did view discussions of uncertain outcomes as a source of confusion or anxiety. However, 12 percent of family members said they did not want to discuss uncertain prognoses, indicating that doctors should not take a 'one-size-fits-all' approach in critical care situations. One of the strongest messages that the above study suggests is that family members want to have this discussion with the physician, and want to have the opportunity to take care of unfinished personal and familial business before their loved one dies. They need that chance to say their goodbyes, in case the patient does die. The results are in line with previous investigations that have looked at patient and family preferences in discussing do-not-resuscitate orders and end-of-life care. In almost all studies, patients and families express a desire for clear information to inform their decisions. Although physicians often wish to shelter their patients and patient families from what might seem to be harsh realities, the human spirit is resilient.
American Journal of Respiratory and Critical Care Medicine
December 2008