title: Approaching patients and family members who hope for a miracle.
abstract: A clinical problem may arise when caring for patients or their surrogates who prefer continued aggressive care based on the belief that a miracle will occur, despite a clinician's belief that further medical treatment is unlikely to have any meaningful benefit. An evidence-based approach is provided for the clinician by breaking this complex clinical problem into a series of more focused clinical questions and subsequently answering them through a critical appraisal of the existing medical literature. Belief in miracles is found to be common in the United States and is an important determinant of how decisions are made for those with advanced illness. There is a growing amount of evidence that suggests end-of-life outcomes improve with the provision of spiritual support from medical teams, as well as with a proactive approach to medical decision making that values statements given by patients and family members.
authors.affiliation: Department of Veterans Affairs Medical Center, San Francisco, California 94121, USA. eric.widera@ucsf.edu
authors.forename: Eric W
authors.initials: EW
authors.lastname: Widera
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Rosenfeld
authors.forename: Erik K
authors.initials: EK
authors.lastname: Fromme
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Sulmasy
authors.forename: Robert M
authors.initials: RM
authors.lastname: Arnold
mesh_terms: D003142:Communication; D019317:Evidence-Based Medicine; D005190:Family; D006801:Humans; D010817:Physician-Patient Relations; D012068:Religion and Medicine; D012931:Social Environment; D013727:Terminal Care; D014481:United States