In the JournalsPerspective

Most older patients prefer not to discuss life expectancy

Nancy Schoenborn
Nancy L. Schoenborn

The majority of older adults did not want to talk about life expectancy with their primary care providers, according to findings recently published in Annals of Family Medicine.

“Only a few studies have examined the perspectives of older adults who do not have cancer and who are not at the end of life regarding whether they want to discuss life expectancy. These studies have found that most participants wanted to have the discussion but often did not further explore their preferences for when or how to do so,” Nancy L. Schoenborn, MD, MHS, assistant professor of medicine at The Johns Hopkins University School of Medicine and colleagues wrote.

Researchers presented 878 patients (mean age, 73.4 years) with a hypothetical situation that depicted a patient other than themselves with limited life expectancy but not expected to die in the near future.

They found that 59.4% did not want to discuss how long they might live in such a situation. Within that subgroup, 59.9% did not think that the doctor should offer the discussion and 87.7% also did not want the doctor to discuss life expectancy with family or friends. Of the original 878 patients, 55.8% wanted to discuss life expectancy only if it were less than 2 years.

Schoenborn provided insight into which patients may be willing to discuss this potentially difficult subject matter.

“First, assess whether the patient has had any experience discussing life expectancy of a loved one, and whether the patient believes that doctors can predict life expectancy to help inform how amenable the patient is to discussing life expectancy,” she told Healio Family Medicine.

Researchers also found patients with more than a college education were also willing to have life expectancy discussions with their doctors.

Schoenborn and colleagues noted that since a patient’s preference may change as he or she grows older, life expectancy discussions should be discussed at multiple time points in the patient’s life. – by Janel Miller

Disclosures: Schoenborn reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

 

Nancy Schoenborn
Nancy L. Schoenborn

The majority of older adults did not want to talk about life expectancy with their primary care providers, according to findings recently published in Annals of Family Medicine.

“Only a few studies have examined the perspectives of older adults who do not have cancer and who are not at the end of life regarding whether they want to discuss life expectancy. These studies have found that most participants wanted to have the discussion but often did not further explore their preferences for when or how to do so,” Nancy L. Schoenborn, MD, MHS, assistant professor of medicine at The Johns Hopkins University School of Medicine and colleagues wrote.

Researchers presented 878 patients (mean age, 73.4 years) with a hypothetical situation that depicted a patient other than themselves with limited life expectancy but not expected to die in the near future.

They found that 59.4% did not want to discuss how long they might live in such a situation. Within that subgroup, 59.9% did not think that the doctor should offer the discussion and 87.7% also did not want the doctor to discuss life expectancy with family or friends. Of the original 878 patients, 55.8% wanted to discuss life expectancy only if it were less than 2 years.

Schoenborn provided insight into which patients may be willing to discuss this potentially difficult subject matter.

“First, assess whether the patient has had any experience discussing life expectancy of a loved one, and whether the patient believes that doctors can predict life expectancy to help inform how amenable the patient is to discussing life expectancy,” she told Healio Family Medicine.

Researchers also found patients with more than a college education were also willing to have life expectancy discussions with their doctors.

Schoenborn and colleagues noted that since a patient’s preference may change as he or she grows older, life expectancy discussions should be discussed at multiple time points in the patient’s life. – by Janel Miller

Disclosures: Schoenborn reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

 

    Perspective
    Alexander K. Smith

    Alexander K. Smith

    Schoenborn and colleagues surveyed a large sample of older adults using an online survey sample. Since the population group in this study are likely to have strong computer skills, the generalizability of these findings remains to be seen. Nonetheless, the “truth” is likely somewhere in the ballpark of what they find. Though the results of the survey were not evenly split, there were still notable percentages on each side of the question’s spectrum.

    When trying to find out the best way to discuss life expectancy, perhaps the best approach is that we do not force such discussions on patients. Instead, we offer to discuss this topic and respect those who do not want to talk about it. Watching the patient’s reaction to this offer will go a long way in determining how much the patient wants to talk about life expectancy.

    Primary care physicians of patients that do want to talk about life expectancy should first ask what the patient thinks his or her actual life expectancy is. Most older adults know they are nearing the end of life and time is not necessarily on their side. If the PCP feels the patient wants to continue the discussion, the PCP should normalize the uncertainty that comes with most life expectancy estimates and provide and discuss the range of years left based on previous patients that have many of the same characteristics. Prognostic calculators, such as those found at ePrognosis.org, can assist in formulating these estimates.

    • Alexander K. Smith, MD, MS, MPH
    • Associate Professor of Medicine, University of California, San Francisco
      department of geriatrics and palliative care, San Francisco Veterans Affairs Medical Center ​

    Disclosures: Smith reports no relevant financial disclosures.