Primary Care Practitioners’ Views on Incorporating Long-term Prognosis in the Care of Older Adults

Schoenborn, Nancy L.; Bowman, Theron L.; Cayea, Danelle; Pollack, Craig Evan; Feeser, Scott; Boyd, Cynthia M.

doi:10.1001/jamainternmed.2016.0670

Cited by 69 publications

(110 citation statements)

References 42 publications

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“…1 How to best communicate life expectancy is not clear and primary care clinicians reports discomfort with these discussions. 2 Literature on life expectancy communication often focuses on patients with cancer or at the end of life. 3 A few studies involving older adults not at the end of life assessed whether older adults wanted to discuss life expectancy but not how or when they want the communication to occur.…”

Section: Introductionmentioning

confidence: 99%

Older Adults’ Preferences for When and How to Discuss Life Expectancy in Primary Care

et al. 2017

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Introduction Life expectancy is important to inform a number of clinical decisions in primary care but its communication is challenging for clinicians. Methods This qualitative interview study with 40 community-dwelling older adults explored their perspectives on how and when to discuss life expectancy in primary care. Results Most participants did not want to discuss life expectancy longer than 1 year but were open to being offered discussion by clinicians. Suggestions included using health decline as trigger for discussion and discussing with family members instead of patient. Discussion Although older adults have varied preferences for the timing and content of life expectancy discussions in primary care, it was generally acceptable for clinicians to offer the opportunity for this type of discussion.

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Section: Introductionmentioning

confidence: 99%

Older Adults’ Preferences for When and How to Discuss Life Expectancy in Primary Care

et al. 2017

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“…4,5 This is especially true for patients without a clearly dominant or near-terminal condition such as advanced dementia or cancer. However, multiple studies show that clinicians' predictions of survival, even in cases of advanced cancer, are often inaccurate and over-optimistic.…”

Section: Estimating Life Expectancymentioning

confidence: 99%

What does the future hold? The need to engage in discussions around prognosis

Scott

2016

Internal Medicine Journal

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“…To better understand PCPs' attitudes and experience estimating and discussing long-term prognosis with older adults, Schoenborn et al 5 interviewed 28 PCPs with busy clinics in 17 different rural, urban, and suburban practices affiliated with Johns Hopkins Community Physicians. Long-term prognosis was loosely defined as a prognosis in the range of years.…”

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confidence: 99%

“…6 These same principles will likely be a useful starting point for PCPs when discussing prognosis with older adults with 5- to 10-year life expectancy. Intuitively, a PCP in the Schoenborn et al 5 study reported using a practice recommended by experts in palliative care when discussing prognosis with patients. The PCP introduces the topic of long-term prognosis by asking patients how long they think they will live and then adjusts the patient's estimate based on clinical knowledge and information from population data.…”

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confidence: 99%