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 Doctors and patients often consider life expectancy when deciding
which preventive measures or treatments will do the most good.
This projection might, for example, 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 might improve the last few decades of life.
“Whether they are aware of it or not, patients have a sense of how
long they have to live and (they) bring this sense of prognosis to
their healthcare decisions,” lead study author Rafael Romo of the
University of California, San Francisco, said by email.
Romo and colleagues asked more than 2,000 adults age 64 and older to
predict their odds of living at least another 10 years and compared
their responses to objective calculations doctors might use as the
basis for clinical recommendations.
Overall, about 55 percent of participants had estimates similar to
the objective calculations, the researchers report in JAMA Internal
Medicine.
But 33 percent of them underestimated how long they might live and
12 percent overestimated their probable longevity.
Unrealistic expectations may make patients less likely to follow
recommended treatments or change long-standing regimens, the authors
argue.
“The logic goes that if patients underestimate their survival they
may not think it is worthwhile to stop smoking, or eat healthy meals
or stay active or undergo cancer screening tests or other preventive
care,” Dr. Victor Montori, an expert in shared decision making at
the Mayo Clinic in Rochester, Minnesota, said by email.
“Conversely, if patients overestimate their survival, they may
demand healthcare from which they cannot derive benefit as they will
run out of time,” added Montori, who wasn’t involved in the study.
Some patients might choose a palliative rather than a curative
approach to end-of-life care, if they realized that whatever time
they had left would be spent enduring the side effects of treatments
they won’t live long enough to benefit from, noted Dr. Rosanne
Leipzig, a geriatrics specialist at the Icahn School of Medicine at
Mount Sinai in New York.
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Others with decades to live might refuse medications to control
their blood pressure or manage diabetes because they didn’t expect
to live very long and wanted to avoid a daily drug regimen that will
benefit them years down the line, Leipzig, who wasn’t involved in
the study, said by email.
When doctors and patients don’t discuss life expectancy, physicians
are likely to err on the side of offering more treatment rather than
less, said Dr. Elizabeth Eckstrom, a geriatrics researcher at Oregon
Health and Sciences University in Portland who wasn’t involved in
the study.
The study findings suggest that patients may often be surprised to
learn they have longer to live than they anticipated, Eckstrom added
by email.
“Patients want to know prognosis to prepare logistically and
financially, to prepare psychologically or spiritually, to prepare
friends and family, to make the most of the time they have left, and
to make health-related decisions,” Eckstrom said.
SOURCE: http://bit.ly/1jySWZM JAMA Internal Medicine, online October
19, 2015.
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