Project Description
Prognosis Communication with Disabled Elders
Prognosis for life expectancy is central to clinical
decision making for disabled older adults.
These include decisions near the
end of life such as, hospice eligibility.
These also include decisions farther upstream, such as intensity of
medication management and monitoring of chronic conditions like diabetes,
hyperlipidemia, or hypertension. From a
patient-centered perspective, disabled older adults and their caregivers often
want to know their life expectancy in order to plan for life choices. These life choices might include moving in
with their children, putting their finances in order, or legacy work.
Based on these considerations, we previously recommended
that clinicians offer to discuss prognosis with disabled elders. In our prior
research, some disabled elders, caregivers, and clinicians expressed legitimate
concerns about the discussion of prognosis.
Might it make people depressed?
Anxious? It prognosis too uncertain
to be useful? We therefore propose this
pilot/exploratory proposal to prepare for an R01-funded trail of prognosis
communication.
We will use qualitative and cognitive interviewing
techniques in individual interviews with disabled older adults (age 70+),
caregivers, and clinicians (n=40-50 total).
We will first determine the best method of displaying life expectancy
information (Aim 1). We also need a
strong clinical-scientific basis for the selection of outcomes for the eventual
trial (Aim 2). Finally, we need to determine design elements, procedures, and
methods for an efficacy trial of prognosis communication to maximize
feasibility and success (Aim 3).
Bio
Alexander Smith, MD, MS, MPH, is an Associate
Professor of Medicine in the Division of Geriatrics at the University of
California, San Francisco. Dr. Smith has a strong interest in issues at the
intersection of bioethics, geriatrics, and palliative care. He works
clinically on the Hospice and Palliative Care Service at the San Francisco
VAMC. He co-founded www.GeriPal.org, a blog about care
of the elderly and palliative care, and ePrognosis.org, a set of online
prognostic calculators. Dr. Smith is a 2009 NPCRC Career Development awardee
and 2015 Pilot/Experimental grant awardee.
Email: aksmith@ucsf.edu