Predict

In the face of life and death, the decision on the duration of resuscitation is of secondary importance. In fact, we more often go one step earlier – to decide whether to go for resuscitation in the first place. This decision is closely linked to our ability to predict the prognosis of our patients.

Unfortunately, numerous studies have shown that doctors are poor in prediction. In general, doctors tend to overestimate the survival of their patients.

How about the perception of the patients themselves? In a recent article, Jane Weeks and coworkers studied 1193 patients who received palliative chemotherapy for metastatic lung or colorectal cancer and remained alive 4 months since the diagnosis [N Engl J Med 2012;367:1616-25]. Despite their advanced disease, only 31% of patients with lung cancer and 19% of those with colorectal cancer reported their disease would unlikely be cured by chemotherapy. In contrast, 25% of patients with lung cancer and 36% of those with colorectal cancer thought cure was very likely.

This study is striking in that the majority of the patients had unrealistic expectation about their prognosis. Since Weeks did not study the doctors or the consultation process, it is difficult to determine if the observation resulted from vague explanations by the doctors or patient denial. However, it is noteworthy that all patients in this study chose to receive chemotherapy and survived for at least 4 months. Perhaps it always takes a little optimism to go on in life.