“Do Older Patients Want to Talk About Life Expectancy?” asks Sheri Potter for AAFP News. She discusses the findings of a new study from the Annals of Family Medicine titled “Older Adults’ Preferences for Discussing Long-Term Life Expectancy: Results From a National Survey.” Clinical practice guidelines increasingly urge physicians to incorporate life expectancy into discussions about preventative care for older patients, and the study offers a window into patient sentiment in various scenarios.
Over 800 adults above the age of 65 were asked to imagine themselves in a scenario where they were not in imminent danger of dying, but they did have a limited life expectancy. In that situation, “Would they want to have a conversation with the doctor about how long they might live? Was it OK for the doctor to bring up this subject? Should the doctor talk to their family and friends about life expectancy? When should the doctor broach this topic?”
The researchers found that 59.4% of participants would not wish to discuss life expectancy. Of those respondents, 59.4% did not think it was appropriate for the physician to raise the topic. 88.7% would not want the doctor to discuss life expectancy with their family or friends.
The study also found that timing was important. “We found that the longer the hypothetical patient was expected to live, the smaller the proportion of participants who wanted to discuss life expectancy,” the authors write. “A sizable minority (16.5 percent) did not wish to have this discussion even when it was one month.” Still, 11% would discuss life expectancy even if it was 20 years.
“Although everyone can probably get behind the notion these are important conversations to have, it’s difficult to implement them in primary care, where there’s a lot of time pressure. We need a trigger to prompt these discussions,” Nancy Schoenborn, M.D., an assistant professor of medicine in the geriatric medicine and gerontology division at Johns Hopkins University School of Medicine in Baltimore, told AAFP News. “Sometimes these patients are sick but stable, and they’re just here for a follow-up. And all of a sudden, having this discussion about how long they might be expected to live blindsides them.”
Researches also found certain personal attributes associated with their responses. For instance, those with higher education have a belief that doctors can accurately predict life expectancy. And those with a past experiences with a life-threatening illness or having previously discussed life expectancy with a loved one are more likely to be open to life expectancy conversations. However, a patient’s belief that religion is important was negatively associated with a willingness to participate in such conversations.
Schoenborn urges physicians to take context into account and consider phrasing. “We have to find a way to present [life expectancy] to patients in a more acceptable way.” Not all patients want to hear this information, and physicians need to be aware of this variation in patient attitudes in order to provide the best care. (AAFP, 11/26, www.aafp.org/news/practice-professional-issues/20181126lifeexpectancy.html; Annals of Family Medicine, Volume 15, Number 6, November/December. 530-537, www.annfammed.org/content/16/6/530.short)