Tips from clinicians about if, when, and how to discuss life expectancy with older adults

Abstract

Objectives: Estimates of life expectancy can inform clinical recommendations and decisions for older adults, but many clinicians find it difficult to discuss. We interviewed primary care clinicians to identify best practices for discussing life expectancy with older adults.

Methods: Twenty-one primary care clinicians (Internal Medicine, Family Medicine, and Geriatrics) completed in-depth interviews on Zoom or by telephone. Topics included estimation and discussion of life expectancy with older patients to guide cancer screening and preventive care decisions. We transcribed, coded, and inductively analyzed interviews using a thematic analysis approach.

Results: Most clinicians recommended individualizing communication about life expectancy versus a standardized approach. Although many clinicians worry that conversations about life expectancy won't go well, successful conversations are possible when clinicians bring humility, care, and attention to these interactions. Clinicians identified seven steps that they find effective for deciding if, when, and how to discuss life expectancy with older patients and detailed tips for using these steps in practice.

Conclusions: Clinicians can take multiple steps to optimize conversations about life expectancy to personalize medical decision making.

Practice implications: The tips and language presented provide a helpful starting point for clinicians to have conversations about life expectancy and appropriate care with older adults.

Keywords: Life expectancy; Medical decision making; Patient-provider communication; Primary care; Prognosis.