Patients with chronic critical illnesses, such as chronic respiratory failure with frequent need for ICU and ventilator support, those with frequent episodes of congestive heart failure, and those with severe liver or kidney disease, have poor long term outlooks. 30-40% die before hospital discharge and another 40% die within the first year following hospital discharge. 90% of survivors end up being dependent on others for activities of daily living.
These are statistics which are generally not appreciated by the general public. When these patients are in the hospital, physicians will sometimes have trouble finding the right way to communicate this to family and surrogates. The best way to communicate is currently being evaluated so that the information is accurate and acceptable to all. Surprisingly, not everyone responds to the same approach.
The options are these: open and honest communication that acknowledges uncertainty but indicates a poor prognosis; no or minimal communication regarding the long term outlook; or communication that acknowledges uncertainty but talks about the potential for a positive outcome (false hope).
Some families and caregivers want the unblemished truth; some would rather not hear anything; and others seem to accept the possibility of a good outcome even when the odds are against it. I have seen families crushed by hearing unfavorable truth, frustrated that no one has spoken to them, and dismayed because they thought everything would work out well.
What is your opinion? Let us know.
