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Don’t beat around the bush: older people on prognoses

Give it to them straight, Doc.

When it comes to important questions about health and death, older adults want to know the truth.

New research has shown that while older Australians want the full picture of their prognosis, even if it is bad news, clinicians are sometimes hesitant to spell it out.

Study lead Associate Professor Magnolia Cardona, from Bond University and Gold Coast University Hospital, said the public may be more willing than clinicians realise to talk openly about what’s in store and how or where they want to die.

The research team surveyed 360 Australian nurses and doctors dealing regularly with patients near the end of life and 497 members of the public, mostly aged 60 or older.

Just under 90 per cent of older adults wanted involvement in treatment decisions if the likelihood of death was high.

And 92 per cent wanted information about life expectancy, but almost 44 per cent of clinicians said uncertainty about life expectancy was a barrier to the conversation.

Another potential roadblock to important chats about prognosis involved loved ones. Just under half (45 per cent) of the clinicians surveyed reported being deterred by family requests to withhold information from patients.

Cardona said: “Arguments that patients cannot handle bad news, and that caregivers request the withholding of discussions about death with terminal patients for fear of distress, may need to be reconsidered in light of this research.

“There is a changing tendency for wanting more disclosure and shared decision-making.”

Study co-author and nurse Ebony Lewis, from UNSW, said while some patients and relatives were ambivalent about or reluctant to discuss poor prognoses, the study showed that the culture of ‘doctor knows best’ was changing and that shared decision-making near end of life should become the norm.

The study’s authors recommended policies to ensure supportive environments for end-of-life discussions and communications training for less experienced clinicians treating terminal older patients.

Cardona added that to align views of disclosure between clinicians and the public, the latter also had a responsibility to question certain treatments, ask for further information, and speak early to their families and GP about their personal values and preferences.

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