ATTITUDE AND SELF-REPORTED PRACTICE REGARDING PROGNOSTICATION IN A NATIONAL SAMPLE OF INTERNISTS

Background: Since prognostication appears increasingly important in cl inical practice, especially in end-of-life care, we examined physician s' experiences and attitudes regarding it. Methods: 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 interv iews with 20. Results: On an annual basis, the typical internist addre ssed the question ''How long do I have to live?'' 10 times, withdrew o r withheld life support 5 times, and referred 5 patients to hospice. N evertheless, physicians disdain prognostication: 60.4% find it ''stres sful'' to make predictions; 58.7% find it ''difficult''; 43.7% wait to be asked by a patient before offering predictions; 80.2% believe pati ents expect too much certainty; 50.2% believe that if they were to mak e an error, patients might lose confidence; 89.9% believe they should avoid being too specific; and 56.8% report inadequate training in prog nostication. 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 we eks. Conclusions: Physicians (1) commonly encounter situations that re quire prognostication, (2) feel poorly prepared for prognostication, ( 3) find it stressful and difficult to make predictions, (4) believe th at patients expect too much certainty and might judge them adversely f or prognostic errors, and (5) vary in how they regard the key concept of being ''terminally ill.'' These observations may have significant c onsequences for patient care.