Jared Chiarchiaro|Praewpannarai Buddadhumaruk|Robert M. Arnold|Douglas B. White
Quality of Communication in the ICU and Surrogate’s Understanding of Prognosis*
University of Pittsburgh|University of Pittsburgh|University of Pittsburgh|University of Pittsburgh Medical Center|University of Pittsburgh|Ethics and Public Policy Center
although misperceptions prognosis surrogates icus common influence treatment decisions validated practical way measure effectiveness prognostic communication surrogates subjective ratings quality communication used domains markers effectiveness communication sought determine whether surrogates subjective ratings quality prognostic communication predict accurate expectation prognosis surrogateswe performed crosssectional cohort study surrogates rated quality prognostic communication survey physicians surrogates gave percentage estimate patient survival icu day 3 0100 probability scale defined discordance prognosis difference physicians surrogates estimates greater equal 20 used multilevel logistic regression modeling account clustering physicians patients adjust confoundersmedicalsurgical trauma cardiac neurologic icus five us academic medical centers located california pennsylvania washington north carolina massachusettstwo hundred seventyfive patients acute respiratory distress syndrome high risk death severe functional impairment 546 surrogate decision makers 150 physiciansnonethere predictive utility surrogates ratings quality communication prognosis identify inaccurate expectations prognosis odds ratio 104 007 p 054 surrogates subjective ratings quality communication prognosis high assessed variety questions discordant prognostic estimates present 635 95 ci 590679 physiciansurrogate pairsalthough surrogates rate quality prognostic communication high inaccurate expectations prognosis common among surrogates surrogates ratings quality prognostic communication reliably predict accurate expectation prognosis