Imminent Death: How Good Are Doctors’ Guesses?

What is already known on this topic

Doctors’ prognostic estimates are a central element of both patient and physician decision making, especially at the end of life

Doctors’ prognostic estimates in their terminally ill patients are often wrong and usually optimistic

What this study adds

A prospective cohort study of 504 terminally ill patients and their 365 doctors found that only 20% of the doctors’ predictions were accurate: 63% were overoptimistic and 17% overpessimistic

Multivariate modelling showed that most types of doctors are prone to error, in most types of patients

The greater the experience of the doctor the greater the prognostic accuracy, but a stronger doctor-patient relationship is associated with lower prognostic accuracy.

As one commentator on the study put it,

Doctors may be reluctant to acknowledge that patients they know well are close to death. This can be compounded by the patient’s and family’s preference to keep hoping for the patient to live longer. Those of us who know our patients longer often become attached to them. We, too, hate to admit that death is near.

The implications of their findings, according to the study’s authors, are that:

Firstly, undue optimism about survival prospects may contribute to late referral for hospice care, with negative implications for patients. . . . Secondly, to the extent that doctors’ implicit or explicit communication of prognostic information affects patients’ own conceptions of their future, doctors may contribute to patients making choices that are counterproductive. . . .Thirdly, our work hints at corrective techniques that might be used to counteract prognostic error. Disinterested doctors, with less contact with the patient, may give more accurate prognoses, perhaps because they have less personal investment in the outcome.