KS-012049 eCQ 11-2 Newsletter

Older Adults Reluctant to Discuss Long-Term Life Expectancy, But More Willing As Time Shortens

for easing into a conversation about the patient’s own situation and preferences, she points out. Preferences for life expectancy discus- sions did not differ by participant sociode- mographic or medical characteristics, note the authors. “Rather, the preferences for discussing life expectancy were associ- ated with past experiences and whether one believed that life expectancy can be predicted.” Participants, both those who did and did not want a discussion, were about evenly divided on how they would want a five- year life expectancy presented, with 51.1% favoring a quantitative description (“about a 50/50 chance to live another five years”) over the more qualitative description (“in the range of a few years”). Based on their findings, the authors suggest several approaches physicians can use to assess whether and when patients are ready for life expectancy discussions. PHYSICIANS CAN: • Explore the patient’s past experiences with serious illness and life expectancy discussions and his/her beliefs about physician predictions. • Because a patient’s attitude and prefer- ences may change over time, assess preferences at multiple time points. • Approach the conversation when life expectancy is closer to two years, which more patients may find acceptable. • Incorporate life expectancies to inform and guide care recommendations, re- gardless of whether the patient wishes to discuss estimated survival time him/ herself. Source: “Older Adults’ Preferences for Discussing Long-Term Life Expectancy: Results from a National Survey,” Annals of Family Medicine; November 2018; 16(6):530–537. Schoenborn NL, Janssen EM, Boyd C, Bridges JFP, Wolff AC, Xue KL, Pollack CE; The Johns Hopkins School of Medicine and School of Public Health, Baltimore; ICON Plc, Gaithersburg, Maryland; Department of Biomedical Informatics, Ohio State University, Columbus.

and 87.7%would not want the physician to discuss life expectancywith their fam- ily and/or friends. • Among those willing to discuss life expectancy, 94.8% were amenable to introduction of the topic by the physi- cian, as long as they had the option to decline. • The reason most often given for want- ing a discussion was that it would help patients plan their lives (72.3%). • 55.8% of participants were willing to have the discussion only if life expec- tancy were less than two years. “We found that the longer the hypotheti- cal patient was expected to live, the smaller the proportion of participants who wanted to discuss life expectancy,” write the au- thors. “A sizable minority (16.5%) did not wish to have this discussion, even when it was one month.” At the other extreme, 11%of participants were fine with discuss- ing life expectancy even as far distant as 20 years. • Higher education level (odds ratio [OR] for college degree and above, 2.18; 95% confidence interval [CI], 1.25 to 3.80; P = 0.004 across categories) • Belief that physicians can accurately predict life expectancy (OR, 3.06; 95% CI, 1.93 to 4.86; P < 0.001) • Past experience with a life-threatening illness (OR, 1.50; 95% CI, 1.07 to 2.09; P = 0.02) • Having previously discussed life expec- tancy of a loved one (OR, 3.98; 95%CI, 2.82 to 5.62; P < 0.001) “My patients often talk about being a caregiver for another family member or tell me if there’s been a recent death in their family,” says lead author and geriatrician Nancy L. Schoenborn, MD, MHS, of Johns Hopkins University School of Medicine. This type of personal patient information can provide clinicians with a starting point FACTORS ASSOCIATED WITH WANTING A LIFE EXPECTANCY DISCUSSION INCLUDED:

Most older adults in a national survey said they would prefer not to discuss life expectancy when asked to imagine them- selves as a hypothetical patient with serious illnesses who was not imminently dying and had an unspecified length of time to live.As the projected time until death grew shorter, however, participants’willingness for discussions increased. “This study is, to our knowledge, the first to assess older adults’ preferences for discussing life expectancy outside of the context of cancer or end of life in a large national sample,” write the authors of a report published in Annals of Family Medicine. “This is also the first study, to our knowledge, to quantify the preferred timing for discussing life expectancy.” Although many clinical guidelines rec- ommend incorporating ten-year life expec- tancy into care decisions for older patients, “best practices are not well established for communicating long-term life expectancy in a primary care setting when patients may have less than ten years to live but are not at the end of life or do not have a single, life-limiting illness such as cancer,” the authors note. They sought information regarding patient preferences that might help clinicians consider how to approach such a discussion. Investigators analyzed responses of 878 participants (mean age, 73.4 years; female, 55.1%) recruited in 2016 from a nationally representative, online survey panel of U.S. adults aged 65 years or older. Participants were presented with a hypothetical sce- nario of a patient with serious health con- ditions and limitations in daily activities, and asked to consider their communication preferences about life expectancy if they were that patient. KEY FINDINGS • 59.4% of participants did not want any discussion of how long they might live if they were the patient in the scenario. • Of these, 59.9% did not think the physi- cian should even offer such a discussion,

Page 3

Volume 11, Issue 2

© 2019 by Quality of Life Publishing Co. May not be reproduced without permission of the publisher. 877-513-0099