Investigating critically ill patients' and families' perceptions of likelihood of survival

Objective: This study investigated the perception of chance for survival among critically ill patients and surrogates and compared those perceptions to actual survival and to clinical estimates of illness severity. Secondary aims explored whether select demographic, clinical, or personal measures were associated with different perceptions of chance for survival. Design: Prospective, sequential, observational, survey-based study. Primary measures were perception of chance for survival as compared to actual survival and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores. Setting: Tertiary care, academic medical intensive care unit (MICU). Patients: Subjects were English-speaking adult MICU patients with a MICU length-of-stay greater than three days or their surrogates (n = 100). Results: Respondents tended to be more optimistic regarding chance for survival than supported by actual survival (p = 0.07) or APACHE II tertile (p = 0.34). Secondary analyses found African American race, faith, or religion impacting health decision-making, and higher health status reports were associated with more optimistic perceptions of chance for survival. Conclusion: Patient/surrogate perceptions of chance for survival were not associated with either actual MICU survival or illness severity (APACHE II) highlighting an opportunity to better inform critically ill patients and families regarding prognosis. Clinician recognition of patients' and families' backgrounds and values might set the stage for such discussions.