Session number: 1099
Abstract title: Seriously Ill Older Persons' Communication About And Desire For Prognostic Information
Author(s):
TR Fried - VA Connecticut Healthcare System
EH Bradley - Yale University School of Medicine
Objectives: Recent emphasis has been placed on the need to provide prognostic information to terminally ill patients. Because patterns of communication and desire for prognostic information, especially in diseases other than cancer, are not well understood, we sought to examine communication and desire for information among persons with a range of diseases.
Methods: We assembled a cohort of 205 community-dwelling persons age > 60 years (participation rate 80%) with a primary diagnosis of cancer, CHF, or COPD who had a limited life expectancy according to objective criteria. They were asked their understanding of and desire for information about their prognosis. The doctor (MD) they identified as responsible for that illness was asked about communication regarding prognosis.
Results: Of the 205, 54 (26%) said they had been told by their clinician that they could die and 8 (4%) were given some idea when this could happen (TIME). Of the 197 who were not given TIME, 44% did not want it. In contrast, 64% of MDs said they had told their patient he/she could die, and 23% had provided TIME. Patients who believed they had <2 years to live were more likely to desire TIME (81%) than those who believed they had a longer life expectancy (53%). Significantly more MDs of cancer patients (41%) than MDs of COPD or CHF patients (21-22%) believed their patients had less than one year to live. Significantly fewer (7-8%) of patients believed they had less than one year, but this did not differ by diagnosis.
Conclusions: Although MDs believe they are communicating with their seriously ill patients about their prognosis, patients report they have not been told and a substantial percentage do not want prognostic information. Although MDs of cancer patients had significantly more pessimistic prognoses for their patients than did MDs of COPD and CHF patients, patients' perception of their prognosis did not differ according to their diagnosis.
Impact statement: The profound disagreement between patients and physicians about prognosis communication suggest the contribution of both physician and patient behaviors. Interventions to improve communication need to be sensitive to patients' and caregivers' desire and ability to hear prognostic information.