Attitude and Self-reported Practice Regarding Prognostication in a National Sample of Internists
dc.contributor.author | Christakis, Nicholas A. | |
dc.contributor.author | Iwashyna, Theodore J. | |
dc.date.accessioned | 2008-12-18T20:51:58Z | |
dc.date.available | 2008-12-18T20:51:58Z | |
dc.date.issued | 1998-11-23 | |
dc.identifier.citation | Christakis NA, Iwashyna TJ. Attitude and self-reported practice regarding prognostication in a national sample of internists. Arch Intern Med 1998; 158(21): 2389-95 <http://hdl.handle.net/2027.42/61404> | en |
dc.identifier.uri | https://hdl.handle.net/2027.42/61404 | |
dc.identifier.uri | http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=retrieve&db=pubmed&list_uids=9827791&dopt=citation | |
dc.description.abstract | 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. | en |
dc.description.sponsorship | This study was supported in part by the Soros Foundation Project on Death in America Faculty Scholars Program, New York, NY; by a National Research Service Award dissertation award from the Agency for Health Care Policy and Research, Washington, DC; and by the University of Pennsylvania Center for Bioethics, Philadelphia. | en |
dc.format.extent | 183317 bytes | |
dc.format.mimetype | application/pdf | |
dc.language.iso | en_US | en |
dc.publisher | Archives of Internal Medicine | en |
dc.title | Attitude and Self-reported Practice Regarding Prognostication in a National Sample of Internists | en |
dc.type | Article | en |
dc.subject.hlbsecondlevel | Internal Medicine and Specialities | |
dc.subject.hlbtoplevel | Health Sciences | |
dc.description.peerreviewed | Peer Reviewed | en |
dc.contributor.affiliationum | Pulmonary and Critical Care Medicine, Division of | en |
dc.contributor.affiliationum | Internal Medicine, Department of | en |
dc.contributor.affiliationumcampus | Ann Arbor | en |
dc.identifier.pmid | 9827791 | |
dc.identifier.pmid | 9827791 | |
dc.description.bitstreamurl | http://deepblue.lib.umich.edu/bitstream/2027.42/61404/1/98.Christakis.I.ArchIntMed.pdf | |
dc.owningcollname | Pulmonary & Critical Care Medicine, Division of |
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