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. 2018 Dec;66(12):2367-2371.
doi: 10.1111/jgs.15524. Epub 2018 Oct 22.

"Planting the Seed": Perceived Benefits of and Strategies for Discussing Long-Term Prognosis with Older Adults

Jayaji M Moré  1 , Sean Lang-Brown  2   3 , Rafael D Romo  4 , Sei J Lee  2   3 , Rebecca Sudore  2   3 , Alexander K Smith  2   3
Affiliations

"Planting the Seed": Perceived Benefits of and Strategies for Discussing Long-Term Prognosis with Older Adults

Jayaji M Moré et al. J Am Geriatr Soc. 2018 Dec.

Abstract

Objectives: To characterize the goals and approaches of clinicians with experience discussing long-term prognostic information with older adults.

Design: We used a semistructured interview guide containing 2 domains of perceived benefits and strategies to explore why and how clinicians choose to discuss long-term prognosis, defined as life expectancy on the scale of years, with patients.

Setting: Clinicians from home-based primary care practices, community-based clinics, and academic medical centers across San Francisco.

Participants: Fourteen physicians, including 11 geriatricians and 1 geriatric nurse practitioner, with a mean age of 40 and a mean 9 years in practice.

Measurements: Clinician responses were analyzed qualitatively using the constant comparisons approach.

Results: Perceived benefits of discussing long-term prognosis included establishing realistic expectations for patients, encouraging conversations about future planning, and promoting shared decision-making through understanding of patient goals of care. Communication strategies included adapting discussions to individual patient preferences and engaging in multiple conversations over time. Clinicians preferred to communicate prognosis in words and with a visual aid, although most did not know of a suitable visual aid.

Conclusion: Engaging in customized longitudinal discussions of long-term prognosis aids clinicians in anchoring conversations about future planning and preparing patients for the end of life. J Am Geriatr Soc 66:2367-2371, 2018.

Keywords: communication; goals; life expectancy; prognosis; strategies.

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Figures

Figure 1.
Figure 1.
Proposed framework for achieving desired outcomes and strategies for long-term prognosis communication beginning at age 60. This framework provides recomendations for the incorporation of the goals described by clinicians in this study and other important health and life issues into clinical practice. Clinicians should use prognosis to prioritize topics rather than age if possible, due to the heterogeneity of life expectancy based on age. The authors recommend using ePrognosis.org, an interactive online repository of personalized prognosis calculators, to estimate prognosis. Of note, advanced care planning is anchored in prognosis, and should be addressed throughout. * At no age is life expectancy less than 1 year.
See this image and copyright information in PMC

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