title: Physicians' perceptions of the value of prognostic models: the benefits and risks of prognostic confidence.
abstract: BACKGROUND
  The communication of prognosis in end-of-life (EOL) care is a challenging task that is limited by prognostic uncertainty and physicians' lack of confidence in their prognostic estimates. Clinical prediction models (CPMs) are increasingly common evidence-based tools that may mitigate these problems and facilitate the communication and use of prognostic information in EOL care; however, little is known about physicians' perceptions of the value of these tools.
  
  
  OBJECTIVE
  To explore physicians' perceptions of the value of CPMs in EOL care.
  
  
  METHODS
  Qualitative study using semi-structured individual interviews which were analysed using a constant comparative method.
  
  
  METHODS
  Convenience sample of 17 attending physicians representing five different medical specialties at a single large tertiary care medical centre.
  
  
  RESULTS
  Physicians perceived CPMs as having three main benefits in EOL care: (i) enhancing their prognostic confidence; (ii) increasing their prognostic authority; and (iii) enabling patient persuasion in circumstances of low prognostic and therapeutic uncertainty. However, physicians also perceived CPMs as having potential risks, which include producing emotional distress in patients and promoting prognostic overconfidence in EOL care.
  
  
  CONCLUSIONS
  Physicians perceive CPMs as a potentially valuable means of increasing their prognostic confidence, communication and explicit use of prognostic information in EOL care. However, physicians' perceptions of CPMs also indicate a need to establish broad and consistent implementation processes to engage patients in shared decision making in EOL care, to effectively communicate uncertainty in prognostic information and to help both patients and physicians manage uncertainty in EOL care decisions.
authors.affiliation: Geriatric Medicine, Maine Medical Center, Portland, ME, USA.
authors.forename: Sarah A M
authors.initials: SA
authors.lastname: Hallen
authors.affiliation: Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, ME, USA.
authors.forename: Norbert A M
authors.initials: NA
authors.lastname: Hootsmans
authors.affiliation: Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, ME, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Blaisdell
authors.affiliation: Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, ME, USA.
authors.forename: Caitlin M
authors.initials: CM
authors.lastname: Gutheil
authors.affiliation: Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, ME, USA.
authors.forename: Paul K J
authors.initials: PK
authors.lastname: Han
mesh_terms: D001291:Attitude of Health Personnel; D003142:Communication; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology*; D011379:Prognosis; D036301:Qualitative Research; D018570:Risk Assessment; D013727:Terminal Care / Q000379:methods; D035501:Uncertainty
keywords: clinical prediction models; communication; physician attitudes; prognostication