Yale Bulletin and Calendar

November 7, 2003|Volume 32, Number 10

Older patients may not be prepared
to receive diagnosis, study says

Despite previous reports concluding that patients want full disclosure about their illness, many seriously ill older people and caregivers may not be ready or able to receive information such as life expectancy, research at Yale shows.

Published in the October issue of Journal of the American Geriatrics Society, the study of 214 elderly patients with serious chronic illness found that patients and caregivers frequently disagree with their physicians about whether likely outcome of their illness has been discussed.

"Although physicians have often been blamed for poor communication skills, this study found that many patients do not want prognostic information, raising the question of whether they are ready and/or able to hear what the physician may be telling them," says Dr. Terri R. Fried, associate professor of internal medicine (geriatrics).

Previous studies have found that many seriously ill patients are overly optimistic about their prognosis. While poor physician communication skills have received much attention as a possible cause, there has been little simultaneous examination of what physicians said and what patients heard.

The study subjects had advanced cancer, chronic obstructive pulmonary disease, or congestive heart failure. They were asked a) if their physician had told them they could die of their illness (i.e. discussed prognosis) and b) if their physician had told them how long they had to live (i.e. discussed life-expectancy). Their caregivers and physicians were asked a parallel series of questions. Patients and caregivers were also asked whether they wanted to discuss life expectancy.

After conversations in which clinicians reported that prognosis was discussed, 69% of patients and 62% of caregivers reported that there was no discussion of prognosis. In addition, after conversations in which clinicians reported that life expectancy was discussed, 89% of patients and 82% of caregivers reported that there was no discussion of life expectancy. Of the patients and caregivers who reported that no life expectancy conversation occurred, 40% of the patients and 23% of the caregivers did not want to have a conversation on the topic.

"Although clinicians report they are discussing prognosis, patients and caregivers frequently do not corroborate these reports," says Fried. "Furthermore, many patients do not want prognostic information."

Other authors on the study include Elizabeth H. Bradley and John O'Leary.

-- By Karen Peart

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Campus Notes