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“Knowing is Better”: Preferences of Diverse Older Adults for Discussing Prognosis

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ABSTRACT

BACKGROUND

Prognosis is critical in individualizing care for older adults with late life disability. Evidence suggests that preferences for prognostic information may be culturally determined. Yet little is known about the preferences of diverse elders for discussing prognosis.

OBJECTIVE

To determine the preferences for discussing prognosis of a diverse sample of older adults with late-life disability

DESIGN & PARTICIPANTS

We interviewed 60 older adults with mean age 78 and mean 2.5 Activities of Daily Living dependencies. Participants were recruited from San Francisco’s On Lok program, the first Program of All-inclusive Care for the Elderly (PACE). Participants were interviewed in English, Spanish, and Cantonese, and responded to scenarios in which their doctors estimated they had 5 years and 1 year left to live. Open-ended questions explored the reasons for their responses. Results were analyzed qualitatively using grounded theory.

KEY RESULTS

Sixty-five percent of participants wanted to discuss the prognosis if their doctor estimated they had <5 years to live and 75% if the estimate was <1 year. Three themes were prominent among patients who wanted to discuss prognosis: to prepare, to make the most of the life they had left, and to make medical or health-related decisions. Those who preferred not to discuss prognosis described emotional difficulty, the uncertainty of prognosis, or that it would not be useful. Nearly all participants said that doctors should not make assumptions based on race or ethnicity, though differences between ethnic groups emerged.

CONCLUSIONS

Most patients in this diverse sample of disabled elders were interested in discussing prognosis, while a substantial minority was not. Among those participants who preferred to discuss prognosis, many said that prognostic information would be important as they made difficult medical and personal decisions in late-life. Clinicians should inquire about preferences for discussing prognosis before sharing prognostic estimates.

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Acknowledgements

All authors included in this manuscript have contributed sufficiently to the project to be included as authors. Every person who contributed to the writing of this manuscript is listed as an author.

Funders

Dr. Smith was supported by a pilot grant from the Center for Aging in Diverse Communities, grant no. P30-AG15272 of the Resource Centers for Minority Aging Research program funded by the National Institute on Aging, National Institutes of Health. Additional support was provided by the National Center for Research Resources UCSF-CTSI (UL1 RR024131), Atlantic Philanthropies, the Society of General Internal Medicine, the John A. Hartford Foundation, and the Association of Specialty Professors.

Prior Presentations

This paper has not been previously presented.

Conflicts of Interest

None disclosed.

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Authors and Affiliations

  1. Division of Geriatrics, Department of Medicine, University of California, San Francisco, CA, USA

    Cyrus Ahalt MA, Louise C. Walter MD, Lindsey Yourman MD & Alexander K. Smith MD, MS, MPH

  2. San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA

    Louise C. Walter MD, Lindsey Yourman MD & Alexander K. Smith MD, MS, MPH

  3. On Lok Lifeways, San Francisco, CA, USA

    Catherine Eng MD

  4. Division of General Internal Medicine, Department of Medicine, Medical Effectiveness Research Center for Diverse Populations, University of California, San Francisco, CA, USA

    Eliseo J. Pérez-Stable MD

Authors
  1. Cyrus Ahalt MA
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  2. Louise C. Walter MD
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  3. Lindsey Yourman MD
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  4. Catherine Eng MD
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  6. Alexander K. Smith MD, MS, MPH
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Correspondence to Alexander K. Smith MD, MS, MPH.

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Ahalt, C., Walter, L.C., Yourman, L. et al. “Knowing is Better”: Preferences of Diverse Older Adults for Discussing Prognosis. J GEN INTERN MED 27, 568–575 (2012). https://doi.org/10.1007/s11606-011-1933-0

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  • DOI: https://doi.org/10.1007/s11606-011-1933-0

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