Assurance of Things Hoped for and the Conviction of Things UnseenF. Amos Bailey, MD Jan 18, 2022
Kiker and colleagues recently published in JAMA research regarding the discordance between families prognostic assessment of their loved one with severe acute brain injury. This study found that for anyone caring for people with serious brain injuries (EMTs, EM providers, ICU providers or PC providers) were not surprised that family members often had an overly optimistic prognostic “hope” for their loved ones.
The researchers characterized this difference regarding prognosis between the providers and the family members as an “optimistic belief difference” (OBD). They also noted that the OBD was more likely to occur when the prognosis was less certain and when patients and family represented minoritized racial groups and those that struggled to find social economic resources.
In the discussion the authors note that, “OBD may be difficult to impact, as it reflects an intentional decision by family to believe a different prognosis than was stated.”
I suspect that part of the problem with communications around serious brain injury in this study was that the physicians and other healthcare provider were using a “secular humanist” frame and the families a religious or faith-based frame. The problem is not one of education but developing shared frames of understanding that bridge the secular and the spiritual.
From my own faith-tradition I was reminded of a line from the Epistle to the Hebrews “faith is the assurance of things hoped for and the conviction of things unseen.” It is common for me to hear from patients and families that they have hope in God, or Allah, or other faith traditions and for me to align myself with this hope. Often people have asked me to pray for them. In the years before the pandemic, it was not uncommon for me to have several names in my mind at the time for the “intentions for the mass’” and to light candles afterwards. In doing so I believe that I was building a shared frame.
Many of us now have a primarily “humanist secularist” frame but we still may be “spiritual” even though we are not religious. Engaging our spiritual self may help us connect with patients and families that have “OBD” so we can all get on the same page.
Most people with serious illness and their families can have more than one cognitive frame. They may have accepted their illness even to the point of accepting home hospice but still on that last day could hope and desire that the cancer be cured, or the dementia reversed or that their loved one had not fallen, hit their head, and was now laying here in a bed in an ICU with a serious brain injury. This is not “OBD” rather this is faith and hope.
Kiker WA, Voumard RR, Andrews LIB, et al. Assessment of discordance between physicians and family members regarding prognosis in patients with severe acute brain injury. JAMA Netw Open. 2021;4(10):e2128991. doi: 10.1001/jamanetworkopen.2021.28991