“Knowing is Better”: Preferences of Diverse Older Adults for Discussing Prognosis
- 426 Downloads
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.
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.
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.
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.
KEY WORDSprognosis elderly disability diverse PACE
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.
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.
This paper has not been previously presented.
Conflicts of Interest
- 3.Covinsky KE, Justice AC, Rosenthal GE, Palmer RM, Landefeld CS. Measuring prognosis and case mix in hospitalized elders. The importance of functional status. J Gen Intern Med. Apr. 1997;12(4):203–208.Google Scholar
- 8.American Geriatrics Society Clinical Practice Committee. Breast cancer screening in older women. J. Am. Geriatr. Soc. 2000;48(7):842–844.Google Scholar
- 9.Screening for breast cancer: recommendations and rationale. Ann Intern Med. Sep 3 2002;137(5 Part 1):344–346.Google Scholar
- 30.Wenrich MD, Curtis JR, Ambrozy DA, Carline JD, Shannon SE, Ramsey PG. Dying patients' need for emotional support and personalized care from physicians: perspectives of patients with terminal illness, families, and health care providers. J. Pain Symptom Manage. 2003;25(3):236–246.PubMedCrossRefGoogle Scholar
- 32.Glaser B, Strauss A. Discovery of Grounded Theory. Strategies for Qualitative Research: Sociology Press, 1967.Google Scholar
- 33.Strauss A, Corbin J. Basics of Qualitative Research. Thousand Oaks. CA: Sage; 1998.Google Scholar