Table 1.

Surrogates’ Explanations for Overly Optimistic Interpretations of Grim Prognostic Statements

Need to express optimism

“I always hope for the best outcome for my husband. Even with [a] five percent chance of survival there is still hope. I hold onto hope strongly.”

“I guess I understand that [the patient] may eventually die … I guess I just have to hope more.”

Belief that patients’ fortitude will lead to better-than-predicted outcomes

“I do think that a person’s will to live and their ability to survive very stressful situations can have an impact on whether they are going to survive or not. And we are talking about my father in this case, not just any patient. I know that my father could do better than what the doctor is saying … and I think he will.”

Disbelief of physicians’ ability to prognosticate

“Ultimately I don’t think [doctors] can really know the percent chance of survival unless someone comes in dead.”

“Whenever you get into a percentage, that’s always an iffy proposition. I think any physician would probably tell you that if they say 35%’ to you that they’re not really giving you a real figure because they really couldn’t say … exactly.”

Interpretation of prognosis as a “gist” estimate rather than a precise estimate

“If the doctor says he has a 5% chance of surviving, I find that to be a very difficult statement. I don’t know what the doctor is referring to so I am just readjusting the statement in my own mind based on the understanding that there is small chance that the patient is going to make it. I am still not having the patient have a great chance of survival, but they have some.”

“I don’t give a lot of weight to the individual number. I tend not to trust the individual number as much as the overall feeling that [the physician] is conveying. When [the physician] says 90%, I’m not thinking 9 out [of] 10, I’m thinking that [the physician] is very confident but not entirely sure. So for me that is the important part, not the number. I want that meaning.”