Dev Patel1, Elan D Cohen2, Amber E Barnato3. 1. Department of Anesthesiology, University of Virginia, Charlottesville, VA. 2. Center for Research on Health Care, University of Pittsburgh, Pittsburgh, PA. 3. Center for Research on Health Care, University of Pittsburgh, Pittsburgh, PA; Section of Decision Sciences, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA; Department of Health Policy and Management, Pitt Public Health, University of Pittsburgh, Pittsburgh, PA. Electronic address: aeb2@pitt.edu.
Abstract
PURPOSE: To explore the effect of emotion priming and physician communication behaviors on optimism bias. MATERIALS AND METHODS: We conducted a 5 × 2 between-subject randomized factorial experiment using a Web-based interactive video designed to simulate a family meeting for a critically ill spouse/parent. Eligibility included age at least 35 years and self-identifying as the surrogate for a spouse/parent. The primary outcome was the surrogate's election of code status. We defined optimism bias as the surrogate's estimate of prognosis with cardiopulmonary resuscitation (CPR) > their recollection of the physician's estimate. RESULTS:Of 373 respondents, 256 (69%) logged in and were randomized and 220 (86%) had nonmissing data for prognosis. Sixty-seven (30%) of 220 overall and 56 of (32%) 173 with an accurate recollection of the physician's estimate had optimism bias. Optimism bias correlated with choosing CPR (P < .001). Emotion priming (P = .397), physician attention to emotion (P = .537), and framing of CPR as the social norm (P = .884) did not affect optimism bias. Framing the decision as the patient's vs the surrogate's (25% vs 36%, P = .066) and describing the alternative to CPR as "allow natural death" instead of "do not resuscitate" (25% vs 37%, P = .035) decreased optimism bias. CONCLUSIONS: Framing of CPR choice during code status conversations may influence surrogates' optimism bias.
RCT Entities:
PURPOSE: To explore the effect of emotion priming and physician communication behaviors on optimism bias. MATERIALS AND METHODS: We conducted a 5 × 2 between-subject randomized factorial experiment using a Web-based interactive video designed to simulate a family meeting for a critically ill spouse/parent. Eligibility included age at least 35 years and self-identifying as the surrogate for a spouse/parent. The primary outcome was the surrogate's election of code status. We defined optimism bias as the surrogate's estimate of prognosis with cardiopulmonary resuscitation (CPR) > their recollection of the physician's estimate. RESULTS: Of 373 respondents, 256 (69%) logged in and were randomized and 220 (86%) had nonmissing data for prognosis. Sixty-seven (30%) of 220 overall and 56 of (32%) 173 with an accurate recollection of the physician's estimate had optimism bias. Optimism bias correlated with choosing CPR (P < .001). Emotion priming (P = .397), physician attention to emotion (P = .537), and framing of CPR as the social norm (P = .884) did not affect optimism bias. Framing the decision as the patient's vs the surrogate's (25% vs 36%, P = .066) and describing the alternative to CPR as "allow natural death" instead of "do not resuscitate" (25% vs 37%, P = .035) decreased optimism bias. CONCLUSIONS: Framing of CPR choice during code status conversations may influence surrogates' optimism bias.
Authors: Dustin C Krutsinger; Kelly L O'Leary; Susan S Ellenberg; Cody E Cotner; Scott D Halpern; Katherine R Courtright Journal: Ann Am Thorac Soc Date: 2020-09