Physicians' perceptions of the value of prognostic models: the benefits and risks of prognostic confidence.

BACKGROUND

The communication of prognosis in end-of-life (EOL) care is a challenging task that is limited by prognostic uncertainty and physicians' lack of confidence in their prognostic estimates. Clinical prediction models (CPMs) are increasingly common evidence-based tools that may mitigate these problems and facilitate the communication and use of prognostic information in EOL care; however, little is known about physicians' perceptions of the value of these tools.

OBJECTIVE

To explore physicians' perceptions of the value of CPMs in EOL care.

DESIGN

Qualitative study using semi-structured individual interviews which were analysed using a constant comparative method.

SETTING AND PARTICIPANTS

Convenience sample of 17 attending physicians representing five different medical specialties at a single large tertiary care medical centre.

RESULTS

Physicians perceived CPMs as having three main benefits in EOL care: (i) enhancing their prognostic confidence; (ii) increasing their prognostic authority; and (iii) enabling patient persuasion in circumstances of low prognostic and therapeutic uncertainty. However, physicians also perceived CPMs as having potential risks, which include producing emotional distress in patients and promoting prognostic overconfidence in EOL care.

DISCUSSION AND CONCLUSIONS

Physicians perceive CPMs as a potentially valuable means of increasing their prognostic confidence, communication and explicit use of prognostic information in EOL care. However, physicians' perceptions of CPMs also indicate a need to establish broad and consistent implementation processes to engage patients in shared decision making in EOL care, to effectively communicate uncertainty in prognostic information and to help both patients and physicians manage uncertainty in EOL care decisions.