The effect of framing on surrogate optimism bias: A simulation study

• Published in: Journal of critical care 2016-04, Vol.32, p.85-88
• Main Authors: Patel, Dev, MD, Cohen, Elan D., MS, Barnato, Amber E., MD, MPH, MS, FACPM
• Format: Article
• Language: English
• Subjects: Aged; Cardiopulmonary resuscitation; Cardiopulmonary Resuscitation - psychology; Clinical Decision-Making; Communication; Critical Care; Critical Illness - psychology; Cross-Sectional Studies; Cues; Emotions; Female; Humans; Intensive care; Male; Middle Aged; Object Attachment; Optimism - psychology; Optimism bias; Patient Advocacy - psychology; Physician-Patient Relations; Physicians - psychology; Prognosis; Resuscitation Orders; Surrogate decision making
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2015.11.015

Abstract Purpose To explore the effect of emotion priming and physician communication behaviors on optimism bias. Materials and Methods We conducted a 5 × 2 between-subject randomized factorial experiment using a Web-based interactive video designed to simulate a family meeting for a critically ill spouse/parent. Eligibility included age at least 35 years and self-identifying as the surrogate for a spouse/parent. The primary outcome was the surrogate's election of code status. We defined optimism bias as the surrogate's estimate of prognosis with cardiopulmonary resuscitation (CPR) > their recollection of the physician's estimate. Results Of 373 respondents, 256 (69%) logged in and were randomized and 220 (86%) had nonmissing data for prognosis. Sixty-seven (30%) of 220 overall and 56 of (32%) 173 with an accurate recollection of the physician's estimate had optimism bias. Optimism bias correlated with choosing CPR ( P < .001). Emotion priming ( P = .397), physician attention to emotion ( P = .537), and framing of CPR as the social norm ( P = .884) did not affect optimism bias. Framing the decision as the patient's vs the surrogate's (25% vs 36%, P = .066) and describing the alternative to CPR as “allow natural death” instead of “do not resuscitate” (25% vs 37%, P = .035) decreased optimism bias. Conclusions Framing of CPR choice during code status conversations may influence surrogates' optimism bias.