Program in Medical Ethics, Department of Medicine, University of California, San Francisco, CA, USA.
Med Decis Making. 2010 Jan-Feb;30(1):76-83. doi: 10.1177/0272989X08317012. Epub 2008 Aug 27.
Rationale. Although misunderstandings about prognosis are common in intensive care units (ICUs), little is known about how physicians actually communicate prognostic information.
The authors sought to 1) develop a framework to describe the language physicians use to disclose prognosis, 2) determine whether physicians frame prognostic statements as estimates for populations or estimates for individual patients, and 3) determine whether physicians use the recommended ''ask-tell-ask'' approach when discussing prognosis.
The authors conducted a multicenter, cross-sectional study of 51 audiotaped physician-family conferences about life support decisions in ICUs. They identified each prognostic statement and used grounded theory methods to develop a framework to understand the language physicians use to communicate prognosis.
Physicians prognosticated in 50 of 51 conferences. When discussing prognosis, physicians used qualitative probability statements in 72% (36/50) of conferences, numeric statements in 20% (10/50), absolute statements in 13% (4/32), and nonprobabilistic statements in 40% (20/50). Physicians exclusively used population-based language in 10% (5/50) of conferences, single-event probability statements in 62% (31/50), and both in 28% (14/ 50). In only 2% (1/50) of conferences did physicians ask whether the family wished to hear prognostic information prior to discussing it, and in only 14% of conferences (7/50) did physicians check to verify that families understood the prognostic information.
There is considerable variability in the language used by physicians to disclose prognosis, with only 20% of physicians using quantitative terms. Very few physicians checked whether families understood prognostic information. These findings may provide potential targets for interventions to improve communication about prognosis in ICUs.
尽管在重症监护病房（ICU）中，对预后的误解很常见，但对于医生如何实际传达预后信息知之甚少。
作者进行了一项多中心、横断面研究，对 51 个 ICU 中关于生命支持决策的医生-家属会议进行了录音。他们识别出每个预后陈述，并使用扎根理论方法来制定一个框架，以理解医生用于传达预后的语言。
51 次会议中有 50 次医生进行了预后预测。在讨论预后时，72%（36/50）的会议中医生使用定性概率陈述，20%（10/50）使用数值陈述，13%（4/32）使用绝对陈述，40%（20/50）使用非概率性陈述。10%（5/50）的会议中医生仅使用基于人群的语言，62%（31/50）的会议中使用单一事件概率陈述，28%（14/50）的会议中同时使用这两种语言。只有 2%（1/50）的会议中医生在讨论预后前询问家属是否希望听到预后信息，只有 14%的会议（7/50）中医生检查以确认家属理解预后信息。
医生用来透露预后的语言存在很大的变异性，只有 20%的医生使用定量术语。很少有医生检查家属是否理解预后信息。这些发现可能为改善 ICU 中预后沟通的干预措施提供潜在目标。
