How Clinician-Family Interactions Potentially Impact Clinicians' Conceptualization and Discussions Regarding Prognostic Uncertainties

J Palliat Care. 2020 Jan;35(1):29-33. doi: 10.1177/0825859719845005. Epub 2019 Apr 30.


Objectives: Little is known about how clinicians perceive prognostic uncertainty. Our study objective was to identify factors that influence how prognostic uncertainty is viewed by physicians, as it relates to their communications with families.

Design: Thirty semi-structured interviews with qualitative content analysis (9 surgeons, 16 intensivists, 3 nurse practitioners, and 2 "other" clinicians). We analyzed interviews using qualitative description with constant comparative techniques.

Setting: Open medical, surgical, neurosurgical, and cardiovascular intensive care units (ICUs) in a 900-bed academic, tertiary Houston hospital.

Interventions: None.

Main results: We identified 2 main factors that influence how clinicians perceive prognostic uncertainty and their perceptions about whether and why they communicate prognostic uncertainties to families: (1) Communicating Uncertainty to "Soften the Blow"; and (2) Communicating Uncertainty in Response to Clinicians' Interpretations of Surrogate Decision Makers' Perceptions of Prognostic Uncertainty. We also identified several subthemes.

Conclusions: Clinician-family interactions influence how clinicians perceive prognostic uncertainty in their communications with patients or families. We discuss ethical and clinical implications of our findings.

Keywords: communications; critical care; decision making; prognosis; surrogate decision makers.

MeSH terms

  • Adult
  • Attitude of Health Personnel
  • Communication*
  • Critical Care / methods
  • Critical Care / psychology*
  • Decision Making
  • Family / psychology*
  • Female
  • Health Personnel / psychology*
  • Humans
  • Male
  • Middle Aged
  • Professional-Family Relations*
  • Prognosis
  • Terminal Care / methods
  • Terminal Care / psychology*
  • Uncertainty