Variability in Physician Estimates of Survival for Acute Respiratory Failure in Chronic Obstructive Pulmonary Disease

Abstract

Physician estimates of patient survival often influence clinical decisions. I studied physician estimates of survival for a patient with acute respiratory failure and underlying chronic obstructive pulmonary disease to identify the factors that may influence these estimates. Physicians (n = 205) completed the same patient management problem and estimated the length of survival for the hypothetical patient. Physician estimates of survival were quite variable, ranging from one month to five years. Shorter estimates of survival were associated with acquisition of select case information: subjective information from family members and a professional colleague, and physiologic and functional data previously demonstrated to be predictive of survival. The study suggests that estimates of survival for the same patient may vary among physicians because of different considerations of social and physiologic case information. Physician estimates of patient survival and treatment recommendations may become more uniform with additional education or decision aids regarding the prognostication of survival.