Attitude and self-reported practice regarding prognostication in a national sample of internists.
BACKGROUND
Since prognostication appears increasingly important in clinical practice, especially in end-of-life care, we examined physicians' experiences and attitudes regarding it.


METHODS
We mailed a survey to a national sample of 1311 internists, yielding 697 responses that were analyzed with multivariate models and other means. Findings were supplemented by qualitative comments from 162 physicians and by interviews with 20.


RESULTS
On an annual basis, the typical internist addressed the question "How long do I have to live?" 10 times, withdrew or withheld life support 5 times, and referred 5 patients to hospice. Nevertheless, physicians disdain prognostication: 60.4% find it "stressful" to make predictions; 58.7% find it "difficult"; 43.7% wait to be asked by a patient before offering predictions; 80.2% believe patients expect too much certainty; 50.2% believe that if they were to make an error, patients might lose confidence; 89.9% believe they should avoid being too specific; and 56.8% report inadequate training in prognostication. With respect to the key concept of "terminal" illness, physicians on average believe that such patients should have 13.5+/-11.8 weeks to live, but responses varied substantially from 1 to 75 weeks.


CONCLUSIONS
Physicians (1) commonly encounter situations that require prognostication, (2) feel poorly prepared for prognostication, (3) find it stressful and difficult to make predictions, (4) believe that patients expect too much certainty and might judge them adversely for prognostic errors, and (5) vary in how they regard the key concept of being "terminally ill." These observations may have significant consequences for patient care.
Christakis
N A
NA
Department of Medicine, Population Research Center, University of Chicago, Ill, USA. nchrista@medicine.bsd.uchicago.edu
Iwashyna
T J
TJ
D001291:Attitude of Health Personnel; D001293:Attitude to Death; D004501:Education, Medical; D005260:Female; D017051:Hospice Care; D006801:Humans; D007388:Internal Medicine / Q000193:education; D007407:Interviews as Topic; D008020:Life Support Care; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D011379:Prognosis; D012017:Referral and Consultation; D016414:Resuscitation Orders; D013315:Stress, Psychological / Q000523:psychology; D011795:Surveys and Questionnaires; D013727:Terminal Care; D013997:Time Factors; D014481:United States