How Do You Handle Tough Conversations With Your Patients?

February 06, 2019

Two recent articles suggest that discussing life expectancy and prognosis is tough on both sides of the doctor-patient relationship. That means that physicians may need to redefine what a successful prognosis discussion looks like, using shared decision making and patient-centered approaches, according to palliative care specialists.

The first article was a study published in the Annals of Family Medicine that asked more than 1000 older adults with chronic illnesses when and how they wanted to talk to their physician about life expectancy. Nearly 60% of respondents didn't want to talk about life expectancy at all if the doctor anticipated that they would live at least 10 more years. And 87.7% did not want their physician talking to family or friends about it either.

Patients' interest changed, however, when life expectancy declined to 2 years. Then, 55.8% of patients wanted their doctor to talk to them about it. Almost 17% of respondents didn't want to talk about life expectancy even when it dropped to 1 month.

The second article, in JAMA Internal Medicine, suggested couching prognostic and life-expectancy conversations in "I" statements that pair a physician's hope ("I am hoping that you will have a long time to live with your heart disease") with concern ("but I am also worried that the time may be short, as short as a few years"). These statements allow for the uncertainty of prognosis and also put the patient and provider on the same side against the disease.

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