Skip to main content

Patient Preferences for Discussing Life Expectancy: a Systematic Review



Discussing life expectancy helps inform decisions related to preventive medication, screening, and personal care planning. Our aim was to systematically review the literature on patient preferences for discussing life expectancy and to identify predictors for these preferences.


We searched PubMed, Cochrane Library, Embase, MEDLINE, PsycInfo, and gray literature from inception until 17 February 2021. Two authors screened titles/abstracts and full texts, and extracted data and one author assessed quality. The outcome of interest was the proportion of patients willing to discuss life expectancy. We reported descriptive statistics, performed a narrative synthesis, and explored sub-groups of patients according to patient characteristics.


A total of 41 studies with an accumulated population of 27,570 participants were included, comprising quantitative survey/questionnaire studies (n=27) and qualitative interview studies (n=14). Willingness to discuss life expectancy ranged from 19 to 100% (median 61%, interquartile range (IQR) 50–73) across studies, with the majority (77%) reporting more than half of subjects willing to discuss. There was considerable heterogeneity in willingness to discuss life expectancy, even between studies from patients with similar ages, diseases, and cultural profiles. The highest variability in willingness to discuss was found among patients with cancer (range 19–100%, median 61%, IQR 51–81) and patients aged 50–64 years (range 19–97%, median 61%, IQR 45–87). This made it impossible to determine predictors for willingness to discuss life expectancy.


Most patients are willing to discuss life expectancy; however, a substantial proportion is not. Heterogeneity and variability in preferences make it challenging to identify clear predictors of willingness to discuss. Variability in preferences may to some extent be influenced by age, disease, and cultural differences. These findings highlight the individual and complex nature in which patients approach this topic and stress the importance of clinicians considering eliciting patient’s individual preferences when initiating discussions about life expectancy.

This is a preview of subscription content, access via your institution.

Figure 1
Figure 2
Figure 3


  1. 1.

    Bibbins-Domingo K, U.S. Preventive Services Task Force. Aspirin Use for the Primary Prevention of Cardiovascular Disease and Colorectal Cancer: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2016;164(12):836-845. doi:

    Article  PubMed  Google Scholar 

  2. 2.

    Walter LC, Covinsky KE. Cancer screening in elderly patients: a framework for individualized decision making. JAMA. 2001;285(21):2750-2756. doi:

    CAS  Article  PubMed  Google Scholar 

  3. 3.

    Cho H, Klabunde CN, Yabroff KR, et al. Comorbidity-Adjusted Life Expectancy: A New Tool to Inform Recommendations for Optimal Screening Strategies. Ann Intern Med. 2013;159(10):667-676. doi:

    Article  PubMed  Google Scholar 

  4. 4.

    Ouellet GM, Ouellet JA, Tinetti ME. Principle of rational prescribing and deprescribing in older adults with multiple chronic conditions. Ther Adv Drug Saf. 2018;9(11):639-652. doi:

    Article  PubMed  PubMed Central  Google Scholar 

  5. 5.

    Diabetes CCHFGSP in IC for E with. Guidelines for Improving the Care of the Older Person with Diabetes Mellitus. J Am Geriatr Soc. 2003;51(5s):265-280. doi:

    Article  Google Scholar 

  6. 6.

    Kutner JS, Blatchford PJ, Taylor DH, et al. Safety and Benefit of Discontinuing Statin Therapy in the Setting of Advanced, Life-Limiting Illness. JAMA Intern Med. 2015;175(5):691-700. doi:

    Article  PubMed  Google Scholar 

  7. 7.

    Schoenborn NL, Bowman TL, Cayea D, Pollack CE, Feeser S, Boyd C. Primary Care Practitioners’ Views on Incorporating Long-term Prognosis in the Care of Older Adults. JAMA Intern Med. 2016;176(5):671-678. doi:

    Article  PubMed  PubMed Central  Google Scholar 

  8. 8.

    Mack JW, Smith TJ. Reasons Why Physicians Do Not Have Discussions About Poor Prognosis, Why It Matters, and What Can Be Improved. J Clin Oncol. Published online September 22, 2016. doi:

  9. 9.

    Thai JN, Walter LC, Eng C, Smith AK. “Every Patient is an Individual”: Clinicians Balance Individual Factors When Discussing Prognosis with Diverse Frail Elders. J Am Geriatr Soc. 2013;61(2):264-269. doi:

    Article  PubMed  PubMed Central  Google Scholar 

  10. 10.

    Walczak A, Henselmans I, Tattersall MHN, et al. A qualitative analysis of responses to a question prompt list and prognosis and end-of-life care discussion prompts delivered in a communication support program: Response to end-of-life QPL and discussion prompts. Psychooncology. 2015;24(3):287-293. doi:

    Article  PubMed  Google Scholar 

  11. 11.

    Hagerty RG, Butow PN, Ellis PA, et al. Cancer Patient Preferences for Communication of Prognosis in the Metastatic Setting. J Clin Oncol. 2004;22(9):1721-1730. doi:

    Article  PubMed  Google Scholar 

  12. 12.

    Fujimori M, Uchitomi Y. Preferences of Cancer Patients Regarding Communication of Bad News: A Systematic Literature Review. Jpn J Clin Oncol. 2009;39(4):201-216. doi:

    Article  PubMed  Google Scholar 

  13. 13.

    Winner M, Wilson A, Ronnekleiv-Kelly S, Smith TJ, Pawlik TM. A Singular Hope: How the Discussion Around Cancer Surgery Sometimes Fails. Ann Surg Oncol. 2017;24(1):31-37. doi:

    Article  PubMed  Google Scholar 

  14. 14.

    Hagerty RG, Butow PN, Ellis PM, Dimitry S, Tattersall MHN. Communicating prognosis in cancer care: a systematic review of the literature. Ann Oncol. 2005;16(7):1005-1053. doi:

    CAS  Article  PubMed  Google Scholar 

  15. 15.

    Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. The BMJ. 2009;339. doi:

  16. 16.

    Jackson JL, Kuriyama A, Anton A, et al. The Accuracy of Google Translate for Abstracting Data From Non-English-Language Trials for Systematic Reviews. Ann Intern Med. 2019;171(9):677-679.

    Article  PubMed  Google Scholar 

  17. 17.

    Center for Evidence-Based Management. Critical Appraisal of a Survey. Accessed 16 Jun 2020

  18. 18.

    Critical Appraisal Skills Programme (2018). CASP Qualitative Checklist. Accessed June 16, 2020

  19. 19.

    RStudio Team (2020). RStudio: Integrated Development for R. RStudio, PBC, Boston, MA URL Http://Www.Rstudio.Com/.

    Google Scholar 

  20. 20.

    Pardon K, Deschepper R, Stichele RV, Bernheim J, Mortier F, Deliens L. Preferences of advanced lung cancer patients for patient-centred information and decision-making: A prospective multicentre study in 13 hospitals in Belgium. Patient Educ Couns. 2009;77(3):421-429. doi:

    Article  PubMed  Google Scholar 

  21. 21.

    Pardon K, Deschepper R, Vander Stichele R, et al. Are patients’ preferences for information and participation in medical decision-making being met? Interview study with lung cancer patients. Palliat Med. 2011;25(1):62-70. doi:

    Article  PubMed  Google Scholar 

  22. 22.

    Kistler CE, Lewis CL, Amick HR, Bynum DL, Walter LC, Watson LC. Older adults’ beliefs about physician-estimated life expectancy: a cross-sectional survey. BMC Fam Pract. 2006;7(1):9. doi:

    Article  PubMed  PubMed Central  Google Scholar 

  23. 23.

    Lewis CL, Kistler CE, Amick HR, et al. Older adults’ attitudes about continuing cancer screening later in life: a pilot study interviewing residents of two continuing care communities. BMC Geriatr. 2006;6(1):10. doi:

    Article  PubMed  PubMed Central  Google Scholar 

  24. 24.

    Waller A, Turon H, Bryant J, Zucca A, Evans T-J, Sanson-Fisher R. Medical oncology outpatients’ preferences and experiences with advanced care planning: a cross-sectional study. BMC Cancer. 2019;19(1):63. doi:

    Article  PubMed  PubMed Central  Google Scholar 

  25. 25.

    Waller A, Wall L, Mackenzie L, Brown SD, Tattersall MHN, Sanson-Fisher R. Preferences for life expectancy discussions following diagnosis with a life-threatening illness: a discrete choice experiment. Support Care Cancer Off J Multinatl Assoc Support Care Cancer. 2021;29(1):417-425. doi:

    Article  Google Scholar 

  26. 26.

    Clayton JM, Butow PN, Arnold RM, Tattersall MHN. Discussing life expectancy with terminally ill cancer patients and their carers: a qualitative study. Support Care Cancer. 2005;13(9):733-742. doi:

    Article  PubMed  Google Scholar 

  27. 27.

    Mathie E, Goodman C, Crang C, et al. An uncertain future: The unchanging views of care home residents about living and dying. Palliat Med. 2012;26(5):734-743. doi:

    Article  PubMed  Google Scholar 

  28. 28.

    De Vleminck A, Pardon K, Roelands M, et al. Information preferences of the general population when faced with life-limiting illness. Eur J Public Health. 2015;25(3):532-538. doi:

    Article  PubMed  Google Scholar 

  29. 29.

    Cardona M, Lewis E, Shanmugam S, et al. Dissonance on perceptions of end-of-life needs between health-care providers and members of the public: Quantitative cross-sectional surveys. Australas J Ageing. 2019;38(3):e75-e84. doi:

    Article  PubMed  Google Scholar 

  30. 30.

    Tuck KK, Brod L, Nutt J, Fromme EK. Preferences of Patients With Parkinson’s Disease for Communication About Advanced Care Planning. Am J Hosp Palliat Med. 2015;32(1):68-77. doi:

    Article  Google Scholar 

  31. 31.

    Deschepper R, Bernheim JL, Stichele RV, et al. Truth-telling at the end of life: A pilot study on the perspective of patients and professional caregivers. Patient Educ Couns. 2008;71(1):52-56. doi:

    Article  PubMed  Google Scholar 

  32. 32.

    Sherman AC, Simonton-Atchley S, Mikeal CW, et al. Cancer patient perspectives regarding preparedness for end-of-life care: A qualitative study. J Psychosoc Oncol. 2018;36(4):454-469. doi:

    Article  PubMed  Google Scholar 

  33. 33.

    Harding R, Simms V, Calanzani N, et al. If you had less than a year to live, would you want to know? A seven-country European population survey of public preferences for disclosure of poor prognosis. Psychooncology. 2013;22(10):2298-2305. doi:

    CAS  Article  PubMed  Google Scholar 

  34. 34.

    Wright AA, Mack JW, Kritek PA, et al. Influence of Patients’ Preferences and Treatment Site on Cancer Patients’ End-of-Life Care. Cancer. 2010;116(19):4656-4663. doi:

    Article  PubMed  Google Scholar 

  35. 35.

    Oskay-Özcelik G, Alavi S, Richter R, et al. Expression III: patients’ expectations and preferences regarding physician-patient relationship and clinical management-results of the international NOGGO/ENGOT-ov4-GCIG study in 1830 ovarian cancer patients from European countries. Ann Oncol Off J Eur Soc Med Oncol. 2018;29(4):910-916. doi:

    Article  Google Scholar 

  36. 36.

    Deng LX, Gleason LP, Khan AM, et al. Advance Care Planning in Adults with Congenital Heart Disease: A Patient Priority. Int J Cardiol. 2017;231:105-109. doi:

    Article  PubMed  Google Scholar 

  37. 37.

    Clarke MG, Kennedy KP, MacDonagh RP. Discussing life expectancy with surgical patients: Do patients want to know and how should this information be delivered? BMC Med Inform Decis Mak. 2008;8(1):24. doi:

    Article  PubMed  PubMed Central  Google Scholar 

  38. 38.

    Uchida M, Sugie C, Yoshimura M, et al. Factors associated with a preference for disclosure of life expectancy information from physicians: a cross-sectional survey of cancer patients undergoing radiation therapy. Support Care Cancer. 2019;27(12):4487-4495. doi:

    Article  PubMed  Google Scholar 

  39. 39.

    Schofield PE, Beeney LJ, Thompson JF, Butow PN, Tattersall MHN, Dunn SM. Hearing the bad news of a cancer diagnosis: The Australian melanoma patient’s perspective. Ann Oncol. 2001;12(3):365-371. doi:

    CAS  Article  PubMed  Google Scholar 

  40. 40.

    Shen MJ, Prigerson HG, Ratshikana-Moloko M, et al. Illness Understanding and End-of-Life Care Communication and Preferences for Patients With Advanced Cancer in South Africa. J Glob Oncol. 2018;(4):1-9. doi:

    Article  PubMed  Google Scholar 

  41. 41.

    Tobler D, Greutmann M, Colman JM, Greutmann-Yantiri M, Librach SL, Kovacs AH. Knowledge of and Preference for Advance Care Planning by Adults With Congenital Heart Disease. Am J Cardiol. 2012;109(12):1797-1800. doi:

    Article  PubMed  Google Scholar 

  42. 42.

    Fine A, Fontaine B, Kraushar MM, Rich BR. Nephrologists Should Voluntarily Divulge Survival Data to Potential Dialysis Patients: A Questionnaire Study. Perit Dial Int J Int Soc Perit Dial. 2005;25(3):269-273. doi:

    Article  Google Scholar 

  43. 43.

    Arbabi M, Rozdar A, Taher M, et al. Patients’ Preference to Hear Cancer Diagnosis. Iran J Psychiatry. 2014;9(1):8-13.

    PubMed  PubMed Central  Google Scholar 

  44. 44.

    Fujimori M, Akechi T, Morita T, et al. Preferences of cancer patients regarding the disclosure of bad news. Psychooncology. 2007;16(6):573-581. doi:

    Article  PubMed  Google Scholar 

  45. 45.

    Butow PN. When the diagnosis is cancer: Patient communication experiences and preferences. Published online 1996:8.

  46. 46.

    Schoenborn NL, Janssen EM, Boyd C, et al. Older Adults’ Preferences for Discussing Long-Term Life Expectancy: Results From a National Survey. Ann Fam Med. 2018;16(6):530-537. doi:

    Article  PubMed  PubMed Central  Google Scholar 

  47. 47.

    Kai I, Ohi G, Yano E, et al. Communication between patients and physicians about terminal care: a survey in Japan. Soc Sci Med 1982. 1993;36(9):1151-1159. doi:

    Article  Google Scholar 

  48. 48.

    Vehling S, Kamphausen A, Oechsle K, Hroch S, Bokemeyer C, Mehnert A. The Preference to Discuss Expected Survival Is Associated with Loss of Meaning and Purpose in Terminally Ill Cancer Patients. J Palliat Med. 2015;18(11):970-976. doi:

    Article  PubMed  Google Scholar 

  49. 49.

    Mackenzie LJ, Carey ML, Suzuki E, et al. Agreement between patients’ and radiation oncologists’ cancer diagnosis and prognosis perceptions: A cross sectional study in Japan. PloS One. 2018;13(6):e0198437. doi:

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  50. 50.

    Zafar W, Hafeez H, Jamshed A, Shah MA, Quader A, Yusuf MA. Preferences regarding disclosure of prognosis and end-of-life care: A survey of cancer patients with advanced disease in a lower-middle-income country. Palliat Med. 2016;30(7):661-673. doi:

    Article  PubMed  Google Scholar 

  51. 51.

    O’Donnell AE, Schaefer KG, Stevenson LW, et al. Social Worker–Aided Palliative Care Intervention in High-risk Patients With Heart Failure (SWAP-HF): A Pilot Randomized Clinical Trial. JAMA Cardiol. 2018;3(6):516. doi:

    Article  PubMed  PubMed Central  Google Scholar 

  52. 52.

    Saracino RM, Polacek LC, Applebaum AJ, Rosenfeld B, Pessin H, Breitbart W. Health Information Preferences and Curability Beliefs Among Patients With Advanced Cancer. J Pain Symptom Manage. 2021;61(1):121-127. doi:

    Article  PubMed  Google Scholar 

  53. 53.

    Waller A, Sanson-Fisher R, Nair BR, Evans T. Preferences for End-of-Life Care and Decision Making Among Older and Seriously Ill Inpatients: A Cross-Sectional Study. J Pain Symptom Manage. 2020;59(2):187-196. doi:

    Article  PubMed  Google Scholar 

  54. 54.

    Tang ST, Lee S-YC. Cancer diagnosis and prognosis in Taiwan: Patient preferences versus experiences. Psychooncology. 2004;13(1):1-13. doi:

    Article  PubMed  Google Scholar 

  55. 55.

    Hoesseini A, Dronkers EAC, Sewnaik A, Hardillo JAU, Baatenburg de Jong RJ, Offerman MPJ. Head and neck cancer patients’ preferences for individualized prognostic information: a focus group study. BMC Cancer. 2020;20(1):399. doi:

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  56. 56.

    Ahalt C, Walter LC, Yourman L, Eng C, Pérez-Stable EJ, Smith AK. “Knowing is better”: preferences of diverse older adults for discussing prognosis. J Gen Intern Med. 2012;27(5):568-575. doi:

    Article  PubMed  Google Scholar 

  57. 57.

    Schoenborn NL, Lee K, Pollack CE, et al. Older Adults’ Preferences for When and How to Discuss Life Expectancy in Primary Care. J Am Board Fam Med. 2017;30(6):813-815. doi:

    Article  PubMed  PubMed Central  Google Scholar 

  58. 58.

    Narayan M, Jones J, Portalupi LB, McIlvennan CK, Matlock DD, Allen LA. Patient Perspectives on Communication of Individualized Survival Estimates in Heart Failure. J Card Fail. 2017;23(4):272-277. doi:

    Article  PubMed  Google Scholar 

  59. 59.

    Miyashita M, Sanjo M, Morita T, Hirai K, Uchitomi Y. Good death in cancer care: a nationwide quantitative study. Ann Oncol. 2007;18(6):1090-1097. doi:

    CAS  Article  PubMed  Google Scholar 

  60. 60.

    Chindaprasirt J, Wongtirawit N, Limpawattana P, et al. Perception of a “good death” in Thai patients with cancer and their relatives. Heliyon. 2019;5(7). doi:

  61. 61.

    Parker SM, Clayton JM, Hancock K, et al. A Systematic Review of Prognostic/End-of-Life Communication with Adults in the Advanced Stages of a Life-Limiting Illness: Patient/Caregiver Preferences for the Content, Style, and Timing of Information. J Pain Symptom Manage. 2007;34(1):81-93. doi:

    Article  PubMed  Google Scholar 

  62. 62.

    Robb KA, Simon AE, Miles A, Wardle J. Public perceptions of cancer: a qualitative study of the balance of positive and negative beliefs. BMJ Open. 2014;4(7). doi:

  63. 63.

    Jȩdrzejewski M, Thallinger C, Mrozik M, Kornek G, Zielinski C, Jassem J. Public Perception of Cancer Care in Poland and Austria. The Oncologist. 2015;20(1):28-36. doi:

    Article  PubMed  Google Scholar 

  64. 64.

    Bowling A. Mode of questionnaire administration can have serious effects on data quality. J Public Health. 2005;27(3):281-291. doi:

    Article  Google Scholar 

  65. 65.

    Damarell RA, Morgan DD, Tieman JJ. General practitioner strategies for managing patients with multimorbidity: a systematic review and thematic synthesis of qualitative research. BMC Fam Pract. 2020;21(1):131. doi:

    Article  PubMed  PubMed Central  Google Scholar 

  66. 66.

    Tarrant C, Stokes T, Baker R. Factors associated with patients’ trust in their general practitioner: a cross-sectional survey. Br J Gen Pract. 2003;53(495):798-800.

    PubMed  PubMed Central  Google Scholar 

  67. 67.

    Moser A, Korstjens I. Series: Practical guidance to qualitative research. Part 3: Sampling, data collection and analysis. Eur J Gen Pract. 2017;24(1):9-18. doi:

    Article  PubMed  PubMed Central  Google Scholar 

Download references


We would like to acknowledge Anton Pottegård, University of Southern Denmark and Odense University Hospital, for helping with the conceptualization of the study and preparation of the manuscript. Further, we would like to acknowledge Lucas Morin, Clinical Investigation Unit, University Hospital of Besançon and High-Dimensional Biostatistics for Drug Safety and Genomics, Centre for Epidemiology and Population Health, Paris, for critical comments on the manuscript.

Author information



Corresponding author

Correspondence to Emma Bjørk MScPharm.

Ethics declarations

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information


(DOCX 842 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Bjørk, E., Thompson, W., Ryg, J. et al. Patient Preferences for Discussing Life Expectancy: a Systematic Review. J GEN INTERN MED 36, 3136–3147 (2021).

Download citation


  • life expectancy
  • patient preferences
  • communication