Contributors to intensive care unit clinicians’ predictions of patient outcomes: A qualitative analysis

BACKGROUND: Information about a critically ill patient’s prognosis is important to the shared decision-making process. The factors that physicians and nurses consider when generating their prognoses are not well understood.

OBJECTIVE: To explore the factors that intensive care unit clinicians consider when prognosticating for their patients.

METHODS: Intensive care unit clinicians (physicians and nurses) were asked to predict 6-month survival and describe the patient-related factors that they considered in their prognoses. The reported factors were tallied and compared with predictions of 6-month survival or death and with correct and incorrect predictions.

RESULTS: Physicians and nurses completed 254 and 286 surveys, respectively, for 303 patients. Of 23 factors identified, the 3 most frequently reported were acute conditions, medical history and comorbid conditions, and trajectory. For patients predicted to be alive at 6 months, physicians commonly mentioned the factors procedures and age; nurses mentioned behavior patterns, previous experiences, and social support. For patients predicted to be dead at 6 months, both groups commonly mentioned cancer. Factors with the highest ratios of correct to incorrect predictions reported by physicians were procedures and definitive treatment; those reported by nurses were procedures, behavior patterns, and current functional status.

CONCLUSIONS: Intensive care unit clinicians use various patient factors to inform their prognoses. Clinicians use different factors when predicting survival than when predicting death. Some factors are reported more frequently for correct predictions than for incorrect predictions.

National Institutes of Health