Patient Preferences for Discussing Life Expectancy: a Systematic Review

Abstract

BACKGROUND: Discussing life expectancy helps inform decisions related to preventive medication, screening, and personal care planning. Our aim was to systematically review the literature on patient preferences for discussing life expectancy and to identify predictors for these preferences. METHODS: We searched PubMed, Cochrane Library, Embase, MEDLINE, PsycInfo, and gray literature from inception until 17 February 2021. Two authors screened titles/abstracts and full texts, and extracted data and one author assessed quality. The outcome of interest was the proportion of patients willing to discuss life expectancy. We reported descriptive statistics, performed a narrative synthesis, and explored sub-groups of patients according to patient characteristics. RESULTS: A total of 41 studies with an accumulated population of 27,570 participants were included, comprising quantitative survey/questionnaire studies (n=27) and qualitative interview studies (n=14). Willingness to discuss life expectancy ranged from 19 to 100% (median 61%, interquartile range (IQR) 50-73) across studies, with the majority (77%) reporting more than half of subjects willing to discuss. There was considerable heterogeneity in willingness to discuss life expectancy, even between studies from patients with similar ages, diseases, and cultural profiles. The highest variability in willingness to discuss was found among patients with cancer (range 19-100%, median 61%, IQR 51-81) and patients aged 50-64 years (range 19-97%, median 61%, IQR 45-87). This made it impossible to determine predictors for willingness to discuss life expectancy. DISCUSSION: Most patients are willing to discuss life expectancy; however, a substantial proportion is not. Heterogeneity and variability in preferences make it challenging to identify clear predictors of willingness to discuss. Variability in preferences may to some extent be influenced by age, disease, and cultural differences. These findings highlight the individual and complex nature in which patients approach this topic and stress the importance of clinicians considering eliciting patient's individual preferences when initiating discussions about life expectancy.

Discussing life expectancy: incorporating evidence-based professional training and guidelines into clinical practice

“…Bjork et al’ s review on a total of 41 studies consisted of 23 quantitative survey and 14 qualitative interview studies 1. ‘Willingness to discuss life expectancy ranged from 19% to 100% (median 61%, IQR 50–73) across studies with the majority (77%) reporting more than half of subjects willing to discuss.…”

“…Bjork et al 1 searched literature in PubMed, Cochrane Library, Embase, MEDLINE and PsycInfo for keywords pertaining to life expectancy, patient preferences and communication. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, authors included articles that reported on patient discussion of life expectancy issues across various patient groups 1. Meta-analysis was not performed 1…”

“…Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, authors included articles that reported on patient discussion of life expectancy issues across various patient groups 1. Meta-analysis was not performed 1…”

“…Literature has revealed that contextual discussion of life expectancy helps inform decisions related to screening, preventive measures, treatment options and individual care planning 1 2…”

“…However, several systematic reviews (SRs) have disclosed that HCPs may encounter challenges including lack of appropriate competence and evidence-based guidelines, and imbalance of power between themselves and their patients 2 3. Bjork et al conducted an SR with the purpose of providing ‘a comprehensive overview of the literature on patient preferences for discussing life expectancy and to identify predictors for willingness to discuss life expectancy’ 1…”