Since prognostication appears increasingly important in clinical practice, especially in end-of-life care, we examined physicians'experiences and attitudes regarding it.
We mailed a survey to a national sample of 1311 internists, yielding 697 responses that were analyzed with multivariate models and other means.
Findings were supplemented by qualitative comments from 162 physicians and by interviews with 20.
On an annual basis, the typical internist addressed the question « How long do I have to live ? » 10 times, withdrew or withheld life support 5 times, and referred 5 patients to hospice.
Nevertheless, physicians disdain prognostication :
60.4% find it « stressful » to make predictions ;
58.7% find it « difficult » ;
43.7% wait to be asked by a patient before offering predictions ;
80.2% believe patients expect too much certainty ;
50.2% believe that if they were to make an error, patients might lose confidence ;
89.9% believe they should avoid being too specific ;
and 56.8% report inadequate training in prognostication.
With respect to the key concept of « terminal » illness, physicians on average believe that such patients should have 13.5 ± 11.8 weeks to live, but responses varied substantially from 1 to 75 weeks. (...)
Mots-clés Pascal : Expérience professionnelle, Médecin, Pronostic, Echelle évaluation, Stade terminal, Questionnaire, Formation professionnelle, Application médicale
Mots-clés Pascal anglais : Professional experience, Physician, Prognosis, Evaluation scale, Terminal stage, Questionnaire, Occupational training, Medical application
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 99-0022650
Code Inist : 002B30A05. Création : 31/05/1999.