Extent and determinants of error in doctors' prognoses in terminally ill patients: prospective cohort study

Objective To describe doctors' prognostic accuracy in terminally ill patien ts and to evaluate the determinants of that accuracy. Design Prospective cohort study. Setting Five outpatient hospice programmes in Chicago. Participants 343 doctors provided survival estimates for 468 terminally ill patients at the time of hospice referral. Main outcome measures Patients' estimated and actual survival. Results Median survival was 24 days. Only 20% (92/468) of predictions were accurate (within 33% of actual survival); 63% (295/468) were overoptimistic and 17% (81/468) were over-pessimistic. Overall, doctors overestimated sur vival by a factor of 5.3. Few patient or doctor characteristics were associ ated with prognostic accuracy. Male patients were 58% less likely to have o ver-pessimistic predictions. Non-oncology medical specialists were 326% mor e likely than general internists to make overpessimistic predictions. Docto rs in the upper quartile of practice experience were the most accurate. As duration of doctor-patient relationship increased and time since last conta ct decreased, prognostic accuracy decreased. Conclusion Doctors are inaccurate in their prognoses for terminally ill pat ients and the error is systematically optimistic The inaccuracy is, in gene ral, not restricted to certain kinds of doctors or patients. These phenomen a may be adversely affecting the quality of care given to patients near the end of life.