• Dev Patel, Elan D Cohen, and Amber E Barnato.
• Department of Anesthesiology, University of Virginia, Charlottesville, VA.
• J Crit Care. 2016 Apr 1; 32: 85-8.

PurposeTo explore the effect of emotion priming and physician communication behaviors on optimism bias.Materials And MethodsWe 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.ResultsOf 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.ConclusionsFraming of CPR choice during code status conversations may influence surrogates' optimism bias.Copyright © 2015 Elsevier Inc. All rights reserved.

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