Nancy L Schoenborn1, Ellen M Janssen2,3, Cynthia Boyd4, John F P Bridges2,5, Antonio C Wolff4, Qian-Li Xue4,2, Craig E Pollack4. 1. The Johns Hopkins University School of Medicine, Baltimore, Maryland nancyli@jhmi.edu. 2. The Johns Hopkins University School of Public Health, Baltimore, Maryland. 3. ICON Plc, Gaithersburg, Maryland. 4. The Johns Hopkins University School of Medicine, Baltimore, Maryland. 5. Ohio State University, Department of Biomedical Informatics, Columbus, Ohio.
Abstract
PURPOSE: Clinical practice guidelines recommend incorporating long-term life expectancy to inform a number of decisions in primary care. We aimed to examine older adults' preferences for discussing life expectancy in a national sample. METHODS: We invited 1,272 older adults (aged 65 or older) from a national, probability-based online panel to participate in 2016. We presented a hypothetical patient with limited life expectancy who was not imminently dying. We asked participants if they were that patient, whether they would like to talk with the doctor about how long they may live, whether it was acceptable for the doctor to offer this discussion, whether they want the doctor to discuss life expectancy with family or friends, and when it should be discussed. RESULTS: The 878 participants (69.0% participation rate) had a mean age of 73.4 years. The majority, 59.4%, did not want to discuss how long they might live in the presented scenario. Within this group, 59.9% also 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. Fully 55.8% wanted to discuss life expectancy only if it were less than 2 years. Factors positively associated with wanting to have the discussion included higher educational level, believing that doctors can accurately predict life expectancy, and past experience with either a life-threatening illness or having discussed life expectancy of a loved one. Reporting that religion is important was negatively associated. CONCLUSIONS: The majority of older adults did not wish to discuss life expectancy when we depicted a hypothetical patient with limited life expectancy. Many also did not want to be offered discussion, raising a dilemma for how clinicians may identify patients' preferences regarding this sensitive topic.
PURPOSE: Clinical practice guidelines recommend incorporating long-term life expectancy to inform a number of decisions in primary care. We aimed to examine older adults' preferences for discussing life expectancy in a national sample. METHODS: We invited 1,272 older adults (aged 65 or older) from a national, probability-based online panel to participate in 2016. We presented a hypothetical patient with limited life expectancy who was not imminently dying. We asked participants if they were that patient, whether they would like to talk with the doctor about how long they may live, whether it was acceptable for the doctor to offer this discussion, whether they want the doctor to discuss life expectancy with family or friends, and when it should be discussed. RESULTS: The 878 participants (69.0% participation rate) had a mean age of 73.4 years. The majority, 59.4%, did not want to discuss how long they might live in the presented scenario. Within this group, 59.9% also 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. Fully 55.8% wanted to discuss life expectancy only if it were less than 2 years. Factors positively associated with wanting to have the discussion included higher educational level, believing that doctors can accurately predict life expectancy, and past experience with either a life-threatening illness or having discussed life expectancy of a loved one. Reporting that religion is important was negatively associated. CONCLUSIONS: The majority of older adults did not wish to discuss life expectancy when we depicted a hypothetical patient with limited life expectancy. Many also did not want to be offered discussion, raising a dilemma for how clinicians may identify patients' preferences regarding this sensitive topic.
Authors: Amir Qaseem; Thomas D Denberg; Robert H Hopkins; Linda L Humphrey; Joel Levine; Donna E Sweet; Paul Shekelle Journal: Ann Intern Med Date: 2012-03-06 Impact factor: 25.391
Authors: Cyrus Ahalt; Louise C Walter; Lindsey Yourman; Catherine Eng; Eliseo J Pérez-Stable; Alexander K Smith Journal: J Gen Intern Med Date: 2011-11-30 Impact factor: 5.128
Authors: Christine E Kistler; Carmen L Lewis; Halle R Amick; Debra L Bynum; Louise C Walter; Lea C Watson Journal: BMC Fam Pract Date: 2006-02-11 Impact factor: 2.497
Authors: Mara A Schonberg; Alicia R Jacobson; Maria Karamourtopoulos; Gianna M Aliberti; Adlin Pinheiro; Alexander K Smith; Linnaea C Schuttner; Elyse R Park; Mary Beth Hamel Journal: J Gen Intern Med Date: 2020-03-03 Impact factor: 5.128
Authors: Nancy L Schoenborn; Amanda L Blackford; Corinne E Joshu; Cynthia M Boyd; Ravi Varadhan Journal: J Am Geriatr Soc Date: 2021-09-18 Impact factor: 5.562
Authors: Mara A Schonberg; Christine E Kistler; Adlin Pinheiro; Alicia R Jacobson; Gianna M Aliberti; Maria Karamourtopoulos; Michelle Hayes; Bridget A Neville; Carmen L Lewis; Christina C Wee; Angela Fagerlin; Larissa Nekhlyudov; Edward R Marcantonio; Mary Beth Hamel; Roger B Davis Journal: JAMA Intern Med Date: 2020-06-01 Impact factor: 21.873
Authors: Rachel A Freedman; Christina A Minami; Eric P Winer; Monica Morrow; Alexander K Smith; Louise C Walter; Mina S Sedrak; Haley Gagnon; Adriana Perilla-Glen; Hans Wildiers; Tanya M Wildes; Stuart M Lichtman; Kah Poh Loh; Etienne G C Brain; Pamela S Ganschow; Kelly K Hunt; Deborah K Mayer; Kathryn J Ruddy; Reshma Jagsi; Nancy U Lin; Beverly Canin; Barbara K LeStage; Anna C Revette; Mara A Schonberg; Nancy L Keating Journal: JAMA Oncol Date: 2021-04-01 Impact factor: 33.006
Authors: Matthias Unseld; Gloria M Gager; Feroniki Adamidis; Anna Kitta; Sophie Roider-Schur; Herbert H Watzke; Eva Katharina Masel Journal: Eur J Cancer Care (Engl) Date: 2019-05-29 Impact factor: 2.328