Doctors overestimate survival time of the terminally ill, study says

From Medical Correspondent Elizabeth Cohen

February 18, 2000
Web posted at: 12:21 p.m. EST (1721 GMT)

(CNN) -- Physicians dramatically overestimate the amount of time their terminally ill patients have left to live, according to a new study published in the British Medical Journal.

"Doctors don't want to believe that their treatments and their interventions are not effective," said study author Dr. Nicholas Christakis of the University of Chicago Medical Center. "Doctors really want to believe that the future is better than it really might be."

The Chicago study looked at survival estimates for 486 terminally ill patients given by 343 doctors. Only 20 percent of the predictions were accurate.

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Doctors overestimated the time patients had left to live in 63 percent of the cases. And in some cases, doctors predicted their patients had as much as five time longer to live than they actually did.

Christakis calls this blind optimism, and says it can lead to big problems for families who are preparing for the inevitable. He gave the example of a child who wants to fly across the country before his parent dies.

"The family communicates to the child, 'It's not time to fly in to see your parent yet,' and the child doesn't come and then the person dies the next day or the next week," Christakis said. "The family misses the opportunity to say goodbye to the loved one because the prediction was not reliable."

This kind of inaccuracy is one reason the American Medical Association has started a special education program for doctors in end-of-life care.

"There's no question in my mind that there's a problem and that we do need to fix it," said Dr. Linda Emanuel of the AMA.

Emanuel said one reason for the problem was simply the human condition: "We are not hard-wired to die." She said physicians are only human and continue to fight for life, even in the face of evidence that death is near.

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British Medical Journal
American Medical Association
University of Chicago Hospitals and Health System

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