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. 2017 Nov;65(11):2496-2501.
doi: 10.1111/jgs.15025. Epub 2017 Sep 14.

Prognosis Communication in Late-Life Disability: A Mixed Methods Study

Theresa W Wong  1 , Sean Lang-Brown  2   3 , Rafael D Romo  3   4 , Alvin Au-Yeung  5 , Sei J Lee  2   3 , Patricia J Moran  6 , Jason Karlawish  7 , Rebecca Sudore  2   3 , Josephine Clayton  8   9 , Alexander K Smith  2   3
Affiliations

Prognosis Communication in Late-Life Disability: A Mixed Methods Study

Theresa W Wong et al. J Am Geriatr Soc. 2017 Nov.

Abstract

Importance: Long-term prognosis informs clinical and personal decisions for older adults with late-life disability. However, many clinicians worry that telling patients their prognosis may cause harm.

Objective: To explore the safety of and reactions to prognosis communication in late-life disability.

Design: Participants estimated their own life expectancy and were then presented their calculated life expectancy using a validated prognostic index. We used a semi-structured interview guide to ask for their reactions. Qualitative data were analyzed using constant comparative analysis. Potential psychological and behavioral outcomes in response to receiving one's calculated prognosis were recorded and re-assessed 2-4 weeks later.

Setting: Community-dwelling older adults age 70+ residing in the San Francisco Bay Area.

Participants: Thirty five older adults with a median age of 80 requiring assistance with ≥1 Activity of Daily Living.

Results: Self-estimates of life expectancy were similar to calculated results for 16 participants. 15 estimated their life expectancy to be longer than their calculated life expectancy by >2 years, while 4 shorter by >2 years. An overarching theme of, "fitting life expectancy into one's narrative" emerged from qualitative analysis. Discussing life expectancy led participants to express how they could alter their life expectancy (subtheme "locus of control"), how they saw their present health (subtheme "perceived health"), and their hopes and fears for the remaining years of their lives (subtheme "outlook on remaining years"). Feelings of anxiety and sadness in reaction to receiving calculated prognosis were rare.

Conclusions and relevance: About half of the disabled older adults' self-estimates of prognosis were similar to calculated estimates. Evidence of sadness or anxiety was rare. These data suggest that in most cases, clinicians may offer to discuss prognosis.

Keywords: communication; late-life disability; life expectancy; prognosis.

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Figures

Figure 1
Figure 1
Visual Aid Used to Present Life Expectancy. Interviewers presented life expectancy to participants using this image template. The worst, most likely and best case times were calculated for each participant using the Lee index, a validated prognostic tool for patients with disabilities.–
Figure 2
Figure 2
Concordance in Life Expectancies The participants’ estimated life expectancies and their life expectancies calculated by the Lee Index is plotted, with bars representing the worst to best case ranges of each estimate., Participants whose estimates were discordant and shorter than their calculated life expectancies are at the top of the figure (participants 1–4), and participants whose estimates were discordant and longer than their calculated life expectancies are at the bottom (participants 21–35).
See this image and copyright information in PMC

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