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Optimism bias in understanding neonatal prognoses

Abstract

Objective

Discrepancies between physician and parent neonatal prognostic expectations are common. Optimism bias is a possible explanation.

Study design

Parents interpreted hypothetical neonatal prognoses in an online survey.

Results

Good prognoses tended to be interpreted accurately, while poor prognoses were interpreted as less than the stated value. One-third of participants consistently overstated survival for the three lowest prognoses, compared to the sample as a whole. Three significant predictors of such optimistic interpretations were single-parent status (OR 0.39; 95% CI 0.2–0.75; p = 0.005), African-American descent (OR 3.78; 95% CI 1.63–8.98; p = 0.002) and the belief that physicians misrepresented prognoses (OR 3.11; 95% CI 1.47–6.65; p = 0.003). Participants’ explanations echoed research on optimism bias in clinical and decision science studies.

Conclusion

Participants accepted positive prognoses for critically ill neonates, but reinterpreted negative ones as being unduly pessimistic demonstrating optimism bias.

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Fig. 1: Box plots for difference between participants’ assessments of survival probability and stated prognosis.

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Acknowledgements

The authors would like to thank Deborah Campbell, MD and the Division of Neonatology at Montefiore Children’s Hospital Albert Einstein College of Medicine for their support of this research.

Funding

Division of Neonatology fellow research funds.

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Correspondence to Marlyse F. Haward.

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Nayak, B., Moon, JY., Kim, M. et al. Optimism bias in understanding neonatal prognoses. J Perinatol 41, 445–452 (2021). https://doi.org/10.1038/s41372-020-00773-1

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