A majority of older adults do not wish to discuss life expectancy when presented with a hypothetical scenario on the topic. In a survey of communication around life expectancy, 878 adults age 65 years and older received a description of a hypothetical patient with limited life expectancy who is not imminently dying. Participants were asked, as the hypothetical patient, if they would like to talk with the doctor about how long they might live, if it was acceptable for the doctor to offer such discussion, whether they would want the doctor to discuss life expectancy with family or friends, and when life expectancy should be discussed. Fifty-nine percent of participants (n=515) did not want to discuss how long they might live in the presented scenario. Among these, 291 participants did not think that the doctor should offer discussion, and 450 participants did not want the doctor to discuss life expectancy with family or friends. As estimated life expectancy increased, fewer participants felt that it should be discussed. Fifty-six percent of participants (n=478) only wanted to discuss life expectancy if it were less than two years. Factors associated with wanting to discuss life expectancy included higher educational levels, belief that doctors can predict life expectancy, and past experiences with either a life-threatening illness or with discussing life expectancy of a loved one. Reporting that religion is important was associated with lower odds of choosing to discuss life expectancy. Overall, this research--the first national study to examine these questions--found that long-term life expectancy can be an important factor in health care decisions for older adults, but whether, when, and how to communicate with patients about it is not clear. The authors suggest that strategies to address this topic include assessing patient factors associated with willingness to discuss life expectancy and offering the discussion when closer to the patient's final year of life.
Older Adults' Preferences for Discussing Long-Term Life Expectancy: Results From a National Survey
Nancy L. Schoenborn, MD, MHS, et al
The Johns Hopkins University School of Medicine, Baltimore, Maryland