The prevailing wisdom in healthcare is that a family member’s inability to accept a loved one’s impending death or a dire prognosis relates to miscommunication. This is not without basis. Many studies have shown a lack of understanding about medical risk or low health literacy rates. It’s led to a huge push to talk in “plain language,” especially when discussing bad news. 

The idea, of course, is that if people can comprehend what a clinician is literally saying, they’ll be able to make good decisions about end-of-life care for a family member, or understand when their own medical treatment doesn’t work.

But a new study from the Annals of Internal Medicine indicates that these efforts may be misguided: It’s not wordy consent forms or physician talking at a breakneck pace with highfalutin medical words that leads to misperceptions. It’s that when physicians say things like “five percent chance of survival,” a family member with a loved one in the intensive care unit chooses not to understand. Or as the University of California, San Francisco researchers explained, “inaccurate interpretations of doctors’ prognostications arise partly from optimistic biases rather than simply from misunderstandings.”

Often, optimism is what allows us to keep going, whether it’s in pursuit of a goal at work or to avoid the nickname of Eeyore at one’s place of employment (or for that matter, in one’s family). It’s not infrequently a natural part of the job for those in the medical field, as patients in an oncology trial “often reported that they were told to be hopeful by physicians or nurses who cared for them, both their primary referring medical teams and the staff involved in the clinical trial.” 

Keeping spirits upbeat in a long-term care facility among employees, residents and family members is a worthy pursuit, especially when the financial news is often bleak. When a medical crisis hits, the majority of Americans say they believe in divine intervention. Many of us would say that it’s not anyone’s place to impale those beliefs with the steel blade of pragmatism.

It’s a tricky balance between optimism and false hope, and more study is needed to how to best help family members of residents. But in the meantime, those in long-term can continue to bang the drum for advance directives, promote end-of-life care and encourage honest discussions about death and dying. We can take stock of whether we suffer from optimistic biases ourselves, and what that means at home and work.