Document Detail


Every patient is an individual: clinicians balance individual factors when discussing prognosis with diverse frail elderly adults.
MedLine Citation:
PMID:  23320808     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: To explore clinician choice of whether to discuss prognosis with their frail older patients.
DESIGN: Qualitative interview study.
SETTING: Primary care clinicians were recruited from nursing homes, community-based clinics, and academic medical centers.
PARTICIPANTS: Three geriatric nurse practitioners, nine geriatricians, five general internists, and three family medicine physicians with a mean age of 44 and a mean 12 years in practice. Seventeen clinicians had patient panels with 80% or more community-dwelling outpatients, 13 had patient panels with 50% or more patients aged 85 and older, and 16 had patient panels with 25% or more of patients in a minority group (Asian, African American, Hispanic).
MEASUREMENTS: Clinicians were asked to describe their practice of discussing long-term (<5-year) and short-term (<1-year and 3-month) prognosis. Responses were analyzed qualitatively using constant comparison until thematic saturation was reached.
RESULTS: Clinicians reported individualizing the decision to discuss prognosis with their frail older patients based on clinical circumstances. Common reasons for discussing prognosis included patient had a specific condition with a limited prognosis, to give patients time to prepare, to promote informed medical decision-making, and when patients or families prompted the conversation. Common reasons not to discuss included maintaining hope and avoiding anxiety, cognitive impairment or patient unable to understand prognosis, respect for patients' cultural values, and long-term prognosis too uncertain to be useful.
CONCLUSION: Clinicians caring for frail older adults are generally willing to discuss short- but not long-term prognosis. Clinicians balance individual factors when deciding whether to discuss prognosis.
Authors:
Julie N Thai; Louise C Walter; Catherine Eng; Alexander K Smith
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2013-01-15
Journal Detail:
Title:  Journal of the American Geriatrics Society     Volume:  61     ISSN:  1532-5415     ISO Abbreviation:  J Am Geriatr Soc     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-02-14     Completed Date:  2013-04-09     Revised Date:  2014-02-04    
Medline Journal Info:
Nlm Unique ID:  7503062     Medline TA:  J Am Geriatr Soc     Country:  United States    
Other Details:
Languages:  eng     Pagination:  264-9     Citation Subset:  IM    
Copyright Information:
© 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.
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MeSH Terms
Descriptor/Qualifier:
Activities of Daily Living
Adult
Aged
Attitude of Health Personnel*
Decision Making*
Disabled Persons / psychology*
Female
Frail Elderly*
Humans
Male
Middle Aged
Nursing Homes*
Patient Preference
Physician-Patient Relations / ethics*
Prognosis
Qualitative Research
Quality of Life
Questionnaires
Truth Disclosure / ethics*
Grant Support
ID/Acronym/Agency:
K23 AG040772/AG/NIA NIH HHS; K24 AG041180/AG/NIA NIH HHS; P30 AG015272/AG/NIA NIH HHS; P30-AG15272/AG/NIA NIH HHS; R01 CA134425/CA/NCI NIH HHS; UL1 RR024131/RR/NCRR NIH HHS; UL1 RR024131/RR/NCRR NIH HHS
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