title: "Knowing is better": preferences of diverse older adults for discussing prognosis.
abstract: BACKGROUND
  Prognosis is critical in individualizing care for older adults with late life disability. Evidence suggests that preferences for prognostic information may be culturally determined. Yet little is known about the preferences of diverse elders for discussing prognosis.
  
  
  OBJECTIVE
  To determine the preferences for discussing prognosis of a diverse sample of older adults with late-life disability.
  
  
  METHODS
  We interviewed 60 older adults with mean age 78 and mean 2.5 Activities of Daily Living dependencies. Participants were recruited from San Francisco's On Lok program, the first Program of All-inclusive Care for the Elderly (PACE). Participants were interviewed in English, Spanish, and Cantonese, and responded to scenarios in which their doctors estimated they had 5 years and 1 year left to live. Open-ended questions explored the reasons for their responses. Results were analyzed qualitatively using grounded theory.
  
  
  RESULTS
  Sixty-five percent of participants wanted to discuss the prognosis if their doctor estimated they had <5 years to live and 75% if the estimate was <1 year. Three themes were prominent among patients who wanted to discuss prognosis: to prepare, to make the most of the life they had left, and to make medical or health-related decisions. Those who preferred not to discuss prognosis described emotional difficulty, the uncertainty of prognosis, or that it would not be useful. Nearly all participants said that doctors should not make assumptions based on race or ethnicity, though differences between ethnic groups emerged.
  
  
  CONCLUSIONS
  Most patients in this diverse sample of disabled elders were interested in discussing prognosis, while a substantial minority was not. Among those participants who preferred to discuss prognosis, many said that prognostic information would be important as they made difficult medical and personal decisions in late-life. Clinicians should inquire about preferences for discussing prognosis before sharing prognostic estimates.
authors: Division of Geriatrics, Department of Medicine, University of California, San Francisco, CA, USA.
authors: Cyrus
authors: C
authors: Ahalt
authors: Louise C
authors: LC
authors: Walter
authors: Lindsey
authors: L
authors: Yourman
authors: Catherine
authors: C
authors: Eng
authors: Eliseo J
authors: EJ
authors: Pérez-Stable
authors: Alexander K
authors: AK
authors: Smith
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D006233:Persons with Disabilities / Q000523:psychology*; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D057240:Patient Preference / Q000523:psychology; D010817:Physician-Patient Relations; D011379:Prognosis; D036301:Qualitative Research; D011788:Quality of Life / Q000523:psychology*; D011795:Surveys and Questionnaires; D014342:Truth Disclosure