Are providers overconfident in predicting outcome after cardiac arrest?

Prognostication of patients in coma after cardiac arrest: Public perspectives

“…It is difficult to quantify these risks in clinical practice, due to the self-fulfilling prophecy associated with WLST. However, a recent study by Steinberg et al (2020), concluded that providers tend to be overly optimistic in their outcome predictions, both in terms of predicted survival as well as functional outcome, which suggests a cautious approach towards WLST. This study also found that none of the patients in which health care providers recommended WLST had favorable outcomes (defined as discharged from the hospital to home or acute rehabilitation).…”

“…This study also found that none of the patients in which health care providers recommended WLST had favorable outcomes (defined as discharged from the hospital to home or acute rehabilitation). 22 On the other hand, an international comparison of current guideline adherence in patients with post-anoxic coma suggests variation in and premature use of neuro-prognostic tests, which might increase the risk of inappropriate WLST. 23 The quality of life after post-anoxic coma is perceived as worse with increased severity of the health state description.…”

Cognitive Biases and Shared Decision Making in Acute Brain Injury

“…The difficulty of prognosticating outcomes for patients with SABI is well-documented (►Table 1). [30][31][32][33] One apparent source is the lack of standardized approaches to neurologic prognostication, as needed for orderly heuris-tic formulation, testing, and refinement. The result is that clinicians are imprecise, biased, and overconfident when performing neurologic prognostication for patients with SABI.…”

“…Functional recovery depends not only on physiological status at discharge, but also on the medical and other support provided. 30 Moreover, the evidence needed to evaluate and improve those predictions is typically incomplete. Most studies and clinical reports focus on immediate physical impairments, with few reporting functional status a few months after discharge, and even fewer focusing on long-term, patient-centered, cognitive or neuropsychological outcomes.…”

“…Potential biases are well documented. [30][31][32][33]55 Moreover, people overestimate how well they understand other people. As a result, they have unwarranted confidence in their biased judgments.…”