Factors Influencing Physician Prognosis: A Scoping Review

Amaryllis Ferrand; Jelena Poleksic; Eric Racine

doi:10.1177/23814683221145158

Factors Influencing Physician Prognosis: A Scoping Review

MDM Policy Pract. 2022 Dec 22;7(2):23814683221145158. doi: 10.1177/23814683221145158. eCollection 2022 Jul-Dec.

Authors

Amaryllis Ferrand^{1

2

3}, Jelena Poleksic^{1

4}, Eric Racine^{1

5

6}

Affiliations

¹ Pragmatic Health Ethics Research Unit, Montreal Clinical Research Institute, Montreal, QC, Canada.
² Faculty of Medicine, Department of Biomedical Sciences, University of Montreal, Montreal, QC, Canada.
³ Jewish General Hospital, Division of Neonatal-Perinatal Medicine, Department of Pediatrics, McGill University, Montreal, QC, Canada.
⁴ Faculty of Medicine, University of Western Ontario, London, ON, Canada.
⁵ Departments of Medicine and Social and Preventive Medicine, University of Montreal, Montreal, Canada.
⁶ Biomedical Ethics Unit, McGill University, Montreal, QC, Canada.

Abstract

Introduction. Prognosis is an essential component of informed consent for medical decision making. Research shows that physicians display discrepancies in their prognostication, leading to variable, inaccurate, optimistic, or pessimistic prognosis. Factors driving these discrepancies and the supporting evidence have not been reviewed systematically. Methods. We undertook a scoping review to explore the literature on the factors leading to discrepancies in medical prognosis. We searched Medline (Ovid) and Embase (Ovid) databases for peer-reviewed articles from 1970 to 2017. We included articles that discussed prognosis variation or discrepancy and where factors influencing prognosis were evaluated. We extracted data outlining the participants, methodology, and prognosis discrepancy information and measured factors influencing prognosis. Results. Of 4,723 articles, 73 were included in the final analysis. There was significant variability in research methodologies. Most articles showed that physicians were pessimistic regarding patient outcomes, particularly in early trainees and acute care specialties. Accuracy rates were similar across all time periods. Factors influencing prognosis were clustered in 4 categories: patient-related factors (such as age, gender, race, diagnosis), physician-related factors (such as age, race, gender, specialty, training and experience, attitudes and values), clinical situation-related factors (such as physician-patient relationship, patient location, and clinical context), and environmental-related factors (such as country or hospital size). Discussion. Obtaining accurate prognostic information is one of the highest priorities for seriously ill patients. The literature shows trends toward pessimism, especially in early trainees and acute care specialties. While some factors may prove difficult to change, the physician's personality and psychology influence prognosis accuracy and could be tackled using debiasing strategies. Exposure to long-term patient outcomes and a multidisciplinary practice setting are environmental debiasing strategies that may warrant further research.

Highlights: Literature on discrepancies in physician's prognostication is heterogeneous and sparse.Literature shows that physicians are mostly pessimistic regarding patient outcomes.Literature shows that a physician's personality and psychology influence prognostic accuracy and could be improved with evidence-based debiasing strategies.Medical specialty strongly influences prognosis, with specialties exposed to acutely ill patients being more pessimistic, whereas specialties following patients longitudinally being more optimistic.Physicians early in their training were more pessimist than more experienced physicians.

Keywords: Attitudes; Bias; Ethics; Physician; prognosis.

Publication types

Review