Estimates of future physical functioning by seriously ill hospitalized patients, their families, and their physicians.
OBJECTIVE
To compare prognostic estimates made by seriously ill hospitalized patients, their surrogates, and their physicians about the patients' activities of daily living (ADLs) 2 months after admission; compare the accuracy of their estimates; and identify factors associated with the optimism and accuracy of these estimates.


METHODS
Prospective cohort study.


METHODS
Five teaching hospitals.


METHODS
A subset (n = 716) of patients in the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment.


METHODS
Prognostic estimates of ADL function.


RESULTS
Physicians were less likely than patients or surrogates to give very high or very low estimates for future functioning. Seven of ten (69.3) patients who survived 2 months estimated that they would be functionally independent at Month 2, compared with 58.5 of their surrogates and 49.2 of their physicians. Agreement on prognosis was highest between patients and surrogates (64.2) and lowest between patients and physicians (48.4). Factors significantly associated with an optimistic estimate of independent functioning were better baseline ADL function, male gender, and higher level of education. Patients were significantly more accurate than surrogates and even more so than physicians in predicting independent functioning at Month 2. Worse baseline function and higher income were significantly associated with accurate estimation.


CONCLUSIONS
At hospital admission, seriously ill patients were more optimistic about their prognosis for physical functioning at 2 months, and more accurate in their estimates, than surrogates and physicians. Physicians tended to underestimate the prognosis for future functioning. Physicians should consider patients' and families' estimates before giving advice about treatment options and discharge planning.
Wu
Albert W
AW
Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland 21205, USA. awu@jhsph.edu
Young
Yuchi
Y
Dawson
Neal V
NV
Brant
Larry
L
Galanos
Anthony N
AN
Broste
Steve
S
Landefeld
Seth C
SC
Harrell
Frank E
FE
Lynn
Joanne
J
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D016638:Critical Illness / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D020127:Recovery of Function; D012647:Self-Assessment; D014481:United States