When researchers talked about life expectancy with 28 primary care
providers, the clinicians described several barriers that keep them
from talking about long-term prognosis with their patients including
time constraints as well as a lack of confidence in tools commonly
used to predict how many years patients have left.
“Discussing life expectancy can be difficult or uncomfortable,” said
lead study author Dr. Nancy Schoenborn, a geriatric health
researcher at Johns Hopkins University School of Medicine in
Older adults of similar age can have very different life
expectancies that influence whether they might live long enough to
benefit from treating illnesses or taking medicine to prevent
disease, Schoenborn and colleagues note in JAMA Internal Medicine.
Almost half of elderly people don’t have an accurate sense of how
much longer they’re likely to live previous research has found. This
may lead some of them to make poorly informed medical decisions (see
Reuters Health article of October 20. 2015, here:
An accurate sense of life expectancy might, however, lead a cancer
patient to skip toxic chemotherapy if they’re not likely to live
long enough to benefit from it, or it might encourage someone with
diabetes to make lifestyle changes that could improve the last few
decades of life.
“Many decisions in primary care require a complex balancing of the
potential benefits and potential harms of the decision,” Schoenborn
added by email. “Since life expectancy may change that balance, it
is one piece of information that can be considered to help tailor
medical decisions to each individual patient.”
To get a sense of how primary care providers think about
incorporating life expectancy into medical decisions, Schoenborn and
colleagues interviewed 26 physicians and two nurse practitioners in
a large group practice with multiple sites in rural, suburban and
Twenty of these practitioners said at least 25 percent of their
patients were older adults.
These primary care practitioners reported considering life
expectancy, often in the range of five to 10 years, in several
clinical scenarios in their care of older patients, but said that
they balanced prognosis against various other factors in decision
In particular, they were more reluctant to stop preventive care in
younger patients with a limited life expectancy, even when these
interventions could take many more years to prove beneficial than
patients would likely be alive. They did, however, tend to think
more about long-term prognosis in planning preventive care for
things like cancer screening or diabetes management.
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By the time patients reached their 80s and 90s, however, the
clinicians said they tended to focus more consistently on addressing
advanced directives and goals of care with patients who had a poor
The study is small, and it’s possible that the views of clinicians
in the practice studied might not mirror what happens in other
primary care settings.
To the extent clinicians fail to discuss life expectancy due to a
lack of confidence in being able to predict long-term prognosis,
there are many calculators available online that can help, noted Dr.
Alexander Smith of the University of California, San Francisco (UCSF),
co-author of an editorial accompanying the study.
One such calculator is ePrognosis (http://bit.ly/1S6OfAf) from UCSF.
There are two problems with not accounting for prognosis, Smith said
“Some older adults with a long prognosis are likely to benefit from
tests and treatments that take years to take effect, and if the
clinician relies solely on age-based cutoffs these older adults
might miss out on beneficial treatments,” Smith said.
“On the other hand, those with a short prognosis who receive tests
and treatments (for conditions) that take a long time to develop
experience the risks and harms of these treatments up front, with
very little chance of benefit down the road,” Smith added.
SOURCE: http://bit.ly/1Q6XAGc JAMA Internal Medicine, online April
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