Discussing prognosis with elderly patients

Scholar: Alexander K Smith, MD, MS, MPH

Frail elderly patients who learn their prognosis may change their decisions about medical care and their life plans. For example, patients whose life expectancy is under 10 years might forego cancer screening, modify goals for treating chronic diseases such as diabetes, reduce the number of pills they take, or spend more time visiting relatives. Physicians often shy away from such discussions because of prognostic uncertainty, discomfort, and lack of training.

Physicians often shy away from discussions about prognosis because of uncertainty, discomfort, and lack of training.

Doctors should offer to discuss prognosis with elderly patients, according to Greenwall Faculty Scholar Alex K. Smith, M.D of the University of California San Francisco, because such discussions enhance their ability to make informed medical decisions and realistic life plans in accordance with their values and priorities. In fact, many elderly patients with diminished functional abilities want to discuss prognosis with their doctors. Smith challenges physicians to develop better ways of holding these sensitive discussions. Greenwall Foundation President Dr. Bernard Lo collaborated on this work.

Discussions about prognosis enhance the ability of elderly patients to make informed medical decisions and realistic life plans in accordance with their values and priorities.

This recommendation to offer to discuss prognosis builds on empirical research by Dr. Smith and colleagues. They found that 75 percent of such patients wanted to discuss their prognosis if their doctor estimated they had less than one year to live. A significant minority, however, did not. Offering to discussing prognosis respects patients who do not want to discuss it.

The Greenwall Foundation supported Dr. Smith to carry out this research, which was carried out in collaboration with one of the members of the Faculty Scholars Program Committee.


In other research, Dr. Smith analyzed how physicians can estimate how long elderly patients can be expected to live and adapted these models into easy-to-use online calculators to help physicians estimate prognosis for individual patients.  To access these other articles, click here and here.

To link to Dr. Smith's article in the New England Journal of Medicine article click here.

For press and Internet coverage of Dr. Smith's article, with public discussion, click here, here, and here.

For Dr. Smith's home page, click here.