Estimates of future physical functioning by seriously ill hospitalized patients, their families, and their physicians

Albert W Wu, Yuchi Young, Neal V. Dawson, Larry Brant, Anthony N. Galanos, Steve Broste, Seth C. Landefeld, Frank E. Harrell, Joanne Lynn

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: To compare prognostic estimates made by seriously ill hospitalized patients, their surrogates, and their physicians about the patients' activities of daily living (ADLs) 2 months after admission; compare the accuracy of their estimates; and identify factors associated with the optimism and accuracy of these estimates. DESIGN: Prospective cohort study. SETTING: Five teaching hospitals. PARTICIPANTS: A subset (n = 716) of patients in the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment. MEASUREMENTS: Prognostic estimates of ADL function. RESULTS: Physicians were less likely than patients or surrogates to give very high or very low estimates for future functioning. Seven of ten (69.3%) patients who survived 2 months estimated that they would be functionally independent at Month 2, compared with 58.5% of their surrogates and 49.2% of their physicians. Agreement on prognosis was highest between patients and surrogates (64.2%) and lowest between patients and physicians (48.4%). Factors significantly associated with an optimistic estimate of independent functioning were better baseline ADL function, male gender, and higher level of education. Patients were significantly more accurate than surrogates and even more so than physicians in predicting independent functioning at Month 2. Worse baseline function and higher income were significantly associated with accurate estimation. CONCLUSION: At hospital admission, seriously ill patients were more optimistic about their prognosis for physical functioning at 2 months, and more accurate in their estimates, than surrogates and physicians. Physicians tended to underestimate the prognosis for future functioning. Physicians should consider patients' and families' estimates before giving advice about treatment options and discharge planning.

Original languageEnglish (US)
Pages (from-to)230-237
Number of pages8
JournalJournal of the American Geriatrics Society
Volume50
Issue number2
DOIs
StatePublished - 2002

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Family Physicians
Physicians
Activities of Daily Living
Patient Discharge
Teaching Hospitals
Cohort Studies
Prospective Studies
Education

Keywords

  • Functional status
  • Physician
  • Prognosis
  • Survey

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

Estimates of future physical functioning by seriously ill hospitalized patients, their families, and their physicians. / Wu, Albert W; Young, Yuchi; Dawson, Neal V.; Brant, Larry; Galanos, Anthony N.; Broste, Steve; Landefeld, Seth C.; Harrell, Frank E.; Lynn, Joanne.

In: Journal of the American Geriatrics Society, Vol. 50, No. 2, 2002, p. 230-237.

Research output: Contribution to journalArticle

Wu, Albert W ; Young, Yuchi ; Dawson, Neal V. ; Brant, Larry ; Galanos, Anthony N. ; Broste, Steve ; Landefeld, Seth C. ; Harrell, Frank E. ; Lynn, Joanne. / Estimates of future physical functioning by seriously ill hospitalized patients, their families, and their physicians. In: Journal of the American Geriatrics Society. 2002 ; Vol. 50, No. 2. pp. 230-237.
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abstract = "OBJECTIVES: To compare prognostic estimates made by seriously ill hospitalized patients, their surrogates, and their physicians about the patients' activities of daily living (ADLs) 2 months after admission; compare the accuracy of their estimates; and identify factors associated with the optimism and accuracy of these estimates. DESIGN: Prospective cohort study. SETTING: Five teaching hospitals. PARTICIPANTS: A subset (n = 716) of patients in the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment. MEASUREMENTS: Prognostic estimates of ADL function. RESULTS: Physicians were less likely than patients or surrogates to give very high or very low estimates for future functioning. Seven of ten (69.3{\%}) patients who survived 2 months estimated that they would be functionally independent at Month 2, compared with 58.5{\%} of their surrogates and 49.2{\%} of their physicians. Agreement on prognosis was highest between patients and surrogates (64.2{\%}) and lowest between patients and physicians (48.4{\%}). Factors significantly associated with an optimistic estimate of independent functioning were better baseline ADL function, male gender, and higher level of education. Patients were significantly more accurate than surrogates and even more so than physicians in predicting independent functioning at Month 2. Worse baseline function and higher income were significantly associated with accurate estimation. CONCLUSION: At hospital admission, seriously ill patients were more optimistic about their prognosis for physical functioning at 2 months, and more accurate in their estimates, than surrogates and physicians. Physicians tended to underestimate the prognosis for future functioning. Physicians should consider patients' and families' estimates before giving advice about treatment options and discharge planning.",
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AU - Young, Yuchi

AU - Dawson, Neal V.

AU - Brant, Larry

AU - Galanos, Anthony N.

AU - Broste, Steve

AU - Landefeld, Seth C.

AU - Harrell, Frank E.

AU - Lynn, Joanne

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N2 - OBJECTIVES: To compare prognostic estimates made by seriously ill hospitalized patients, their surrogates, and their physicians about the patients' activities of daily living (ADLs) 2 months after admission; compare the accuracy of their estimates; and identify factors associated with the optimism and accuracy of these estimates. DESIGN: Prospective cohort study. SETTING: Five teaching hospitals. PARTICIPANTS: A subset (n = 716) of patients in the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment. MEASUREMENTS: Prognostic estimates of ADL function. RESULTS: Physicians were less likely than patients or surrogates to give very high or very low estimates for future functioning. Seven of ten (69.3%) patients who survived 2 months estimated that they would be functionally independent at Month 2, compared with 58.5% of their surrogates and 49.2% of their physicians. Agreement on prognosis was highest between patients and surrogates (64.2%) and lowest between patients and physicians (48.4%). Factors significantly associated with an optimistic estimate of independent functioning were better baseline ADL function, male gender, and higher level of education. Patients were significantly more accurate than surrogates and even more so than physicians in predicting independent functioning at Month 2. Worse baseline function and higher income were significantly associated with accurate estimation. CONCLUSION: At hospital admission, seriously ill patients were more optimistic about their prognosis for physical functioning at 2 months, and more accurate in their estimates, than surrogates and physicians. Physicians tended to underestimate the prognosis for future functioning. Physicians should consider patients' and families' estimates before giving advice about treatment options and discharge planning.

AB - OBJECTIVES: To compare prognostic estimates made by seriously ill hospitalized patients, their surrogates, and their physicians about the patients' activities of daily living (ADLs) 2 months after admission; compare the accuracy of their estimates; and identify factors associated with the optimism and accuracy of these estimates. DESIGN: Prospective cohort study. SETTING: Five teaching hospitals. PARTICIPANTS: A subset (n = 716) of patients in the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment. MEASUREMENTS: Prognostic estimates of ADL function. RESULTS: Physicians were less likely than patients or surrogates to give very high or very low estimates for future functioning. Seven of ten (69.3%) patients who survived 2 months estimated that they would be functionally independent at Month 2, compared with 58.5% of their surrogates and 49.2% of their physicians. Agreement on prognosis was highest between patients and surrogates (64.2%) and lowest between patients and physicians (48.4%). Factors significantly associated with an optimistic estimate of independent functioning were better baseline ADL function, male gender, and higher level of education. Patients were significantly more accurate than surrogates and even more so than physicians in predicting independent functioning at Month 2. Worse baseline function and higher income were significantly associated with accurate estimation. CONCLUSION: At hospital admission, seriously ill patients were more optimistic about their prognosis for physical functioning at 2 months, and more accurate in their estimates, than surrogates and physicians. Physicians tended to underestimate the prognosis for future functioning. Physicians should consider patients' and families' estimates before giving advice about treatment options and discharge planning.

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KW - Prognosis

KW - Survey

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