White DB, Carson S, Anderson W, et al. - Researchers conducted a prospective, multicenter cohort study at 12 ICUs from multiple regions of the United States in order to ascertain the causes of optimistic expectations about prognosis among surrogate decision-makers in ICUs and to assess if it is associated with more use of life support at the end of life. They administered surrogates and physicians a validated instrument assessing their prognostic expectations for hospital survival. Findings revealed the prevalence of optimistic expectations about prognosis among surrogates of patients with an advanced critical illness. Misunderstandings by surrogates and surrogates holding more hopeful beliefs resulted in these optimistic expectations compared with what they heard from physicians. These optimistic expectations are associated with a longer duration of intensive treatment at the end of life. Findings thereby emphasize the necessity to generate strategies to increase the comprehensibility of physicians’ prognostications, and also to attend to the emotional and psychologic challenges surrogates face when confronted with news of a poor prognosis.