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  3. Extent and determinants of error in doctors' prognoses in terminally ill patients: prospective cohort studyCommentary: Why do doctors overestimate?Commentary: Prognoses should be based on proved indices not intuition
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Extent and determinants of error in doctors' prognoses in terminally ill patients: prospective cohort studyCommentary: Why do doctors overestimate?Commentary: Prognoses should be based on proved indices not intuition

BMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7233.469 (Published 19 February 2000) Cite this as: BMJ 2000;320:469
  1. Nicholas A Christakis, associate professor (nchrista{at}medicine.bsd.uchicago.edu)a,
  2. Elizabeth B Lamont, fellowb
  1. a Department of Medicine, University of Chicago Medical Center, Chicago, IL 60637, USA
  2. b Robert Wood Johnson Clinical Scholars Program, University of Chicago Medical Center
  3. Hospice of Rochester, Rochester, NY 14607, USA
  4. Chorleywood, Hertfordshire WD3 5AS
  1. Correspondence to: N A Christakis
  • Accepted 5 November 1999

Abstract

Objective: To describe doctors' prognostic accuracy in terminally ill patients and to evaluate the determinants of that accuracy.

Design: Prospective cohort study

Setting: Five outpatient hospice programmes in Chicago

Participants: 343 doctors provided survival estimates for 468 terminally ill patients at the time of hospice referral

Main outcome measures: Patients' estimated and actual survival.

Results: Median survival was 24 days. Only 20% (92/468) of predictions were accurate (within 33% of actual survival); 63% (295/468) were overoptimistic and 17% (81/468) were overpessimistic. Overall, doctors overestimated survival by a factor of 5.3. Few patient or doctor characteristics were associated with prognostic accuracy. Male patients were 58% less likely to have overpessimistic predictions. Non-oncology medical specialists were 326% more likely than general internists to make overpessimistic predictions. Doctors in the upper quartile of practice experience were the most accurate. As duration of doctor-patient relationship increased and time since last contact decreased, prognostic accuracy decreased.

Conclusion: Doctors are inaccurate in their prognoses for terminally ill patients and the error is systematically optimistic. The inaccuracy is, in general, not restricted to certain kinds of doctors or patients. These phenomena may be adversely affecting the quality of care given to patients near the end of life

Footnotes

  • Funding Soros Foundation Project on Death in America Faculty Scholars Program (NAC), the American Medical association Education and Research Foundation (NAC), and the Robert Wood Johnson Clinical Scholars Program (EBL).

  • Competing interests Both authors have occasionally received honorariums for speaking at events sponsored by hospices

  • Accepted 5 November 1999

Commentary: Why do doctors overestimate?

  1. Julia L Smith, medical director (julia.smith{at}viahealth.org)
  1. a Department of Medicine, University of Chicago Medical Center, Chicago, IL 60637, USA
  2. b Robert Wood Johnson Clinical Scholars Program, University of Chicago Medical Center
  3. Hospice of Rochester, Rochester, NY 14607, USA
  4. Chorleywood, Hertfordshire WD3 5AS

    Footnotes

    • Competing interests None declared.

      Commentary: Prognoses should be based on proved indices not intuition

      1. Colin Murray Parkes, consultant psychiatrist (cmparkes{at}aol.com)
      1. a Department of Medicine, University of Chicago Medical Center, Chicago, IL 60637, USA
      2. b Robert Wood Johnson Clinical Scholars Program, University of Chicago Medical Center
      3. Hospice of Rochester, Rochester, NY 14607, USA
      4. Chorleywood, Hertfordshire WD3 5AS

        Footnotes

        • Competing interests None declared.

        • website extra A table showing the results of regression analysis is available on the BMJ's website. www.bmj.com

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