Recommendations For Care Influenced By Doctors’ Perception
Critical care medicine researchers are trying to understand the factors that influence doctors’ perceptions about which patients are likely to survive and those likely to die from septic shock. This insight is necessary to providing more reliable and accurate estimates of outcomes.
“This study uncovered an alarming variation in predicted prognoses among physicians with experience treating septic shock,” says Dr. James O’Brien, a pulmonologist and critical care specialist at the Ohio State University Medical Center. “Physicians presented with identical information predicted dramatically different outcomes for a patient and these predictions were associated with recommendations to continue or discontinue aggressive supportive care.”
The results of the study appear online in Critical Care (ccforum.com), an intensive care journal.
The researchers mailed surveys with mock clinical scenarios to physicians with experience treating septic shock. They asked the participating doctors to make predictions about the likelihood that the patient in the scenario would recover from septic shock and to select a care plan for each hypothetical patient. The scenarios all featured a patient with septic shock and multi-organ failure. The researchers varied some of the clinical characteristics of the mock patient, including age (either 50 years old or 70 years old); weight (either normal or obese); and, patients who either had no prior medical problems or who were recently diagnosed with lung cancer.
Despite all mock scenarios having the same objective measure of severity of illness, responding physicians had an extremely wide range of predictions about the likelihood that a patient would survive and be able to care for him or herself. Beyond this variation, responding physicians predicted significantly worse outcomes for vignettes in which the patient was older, obese or had lung cancer. These expectations about worse outcomes affected the care chosen by the responding physicians.
Physicians were more likely to recommend limiting aggressive care when they also felt the patient was unlikely to survive or recover functional independence, despite the general lack of agreement among physicians as to the likely outcome for each scenario. In addition, physicians were much more likely to recommend limiting aggressive care if the mock patient had lung cancer, even beyond the physician’s expectations about poorer outcomes among these patients.
“These observations raise concern that provided information and resulting decisions about continued aggressive care may be influenced by the individual physician as much as the patient’s status,” says O’Brien, who is also the principal investigator of the study.
According to O’Brien, tools are necessary which incorporate patient characteristics and preferences with physician predictions and practices to assist with outcome predictions.
Sepsis, a systemic response to infection, can lead to organ failure, shock and death. Sepsis affects approximately 750,000 Americans yearly and kills more people than strokes, breast cancer and lung cancer combined.