Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense C, Denmark.
Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark.
J Gen Intern Med. 2021 Oct;36(10):3136-3147. doi: 10.1007/s11606-021-06973-5. Epub 2021 Aug 2.
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.
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.
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.
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.
讨论预期寿命有助于为与预防性药物、筛查和个人护理计划相关的决策提供信息。我们的目的是系统地回顾有关患者对讨论预期寿命的偏好的文献，并确定这些偏好的预测因素。
我们检索了 PubMed、Cochrane 图书馆、Embase、MEDLINE、PsycInfo 和灰色文献，检索时间从建库至 2021 年 2 月 17 日。两位作者筛选标题/摘要和全文，并提取数据，一位作者评估质量。感兴趣的结局是愿意讨论预期寿命的患者比例。我们报告了描述性统计数据，进行了叙述性综合分析，并根据患者特征探索了患者亚组。
共有 41 项研究，共计 27570 名参与者，包括定量调查/问卷调查研究（n=27）和定性访谈研究（n=14）。在所有研究中，愿意讨论预期寿命的比例从 19%到 100%（中位数 61%，四分位距（IQR）50-73），大多数（77%）研究报告超过一半的患者愿意讨论。即使在年龄、疾病和文化特征相似的患者的研究之间，讨论预期寿命的意愿也存在很大差异。在癌症患者（范围 19%-100%，中位数 61%，IQR 51-81）和 50-64 岁患者（范围 19%-97%，中位数 61%，IQR 45-87）中，讨论意愿的差异最大。这使得确定愿意讨论预期寿命的预测因素变得不可能。
大多数患者愿意讨论预期寿命；然而，相当一部分患者不愿意。偏好的异质性和可变性使得确定愿意讨论的明确预测因素具有挑战性。偏好的差异在一定程度上可能受到年龄、疾病和文化差异的影响。这些发现突出了患者在处理这个话题时的个体和复杂性，并强调了临床医生在开始讨论预期寿命时考虑患者个体偏好的重要性。
