Older adults' beliefs about physician-estimated life expectancy: a cross-sectional survey

BACKGROUND: Estimates of life expectancy assist physicians and patients in medical decision-making. The time-delayed benefits for many medical treatments make an older adult's life expectancy estimate particularly important for physicians. The purpose of this study is to assess older adults' beliefs about physician-estimated life expectancy. METHODS: We performed a mixed qualitative-quantitative cross-sectional study in which 116 healthy adults aged 70+ were recruited from two local retirement communities. We interviewed them regarding their beliefs about physician-estimated life expectancy in the context of a larger study on cancer screening beliefs. Semi-structured interviews of 80 minutes average duration were performed in private locations convenient to participants. Demographic characteristics as well as cancer screening beliefs and beliefs about life expectancy were measured. Two independent researchers reviewed the open-ended responses and recorded the most common themes. The research team resolved disagreements by consensus. RESULTS: This article reports the life-expectancy results portion of the larger study. The study group (n = 116) was comprised of healthy, well-educated older adults, with almost a third over 85 years old, and none meeting criteria for dementia. Sixty-four percent (n = 73) felt that their physicians could not correctly estimate their life expectancy. Sixty-six percent (n = 75) wanted their physicians to talk with them about their life expectancy. The themes that emerged from our study indicate that discussions of life expectancy could help older adults plan for the future, maintain open communication with their physicians, and provide them knowledge about their medical conditions. CONCLUSION: The majority of the healthy older adults in this study were open to discussions about life expectancy in the context of discussing cancer screening tests, despite awareness that their physicians' estimates could be inaccurate. Since about a third of participants perceived these discussions as not useful or even harmful, physicians should first ascertain patients' preferences before discussing their life expectancies

Enhancing the Empathic Connection: Using Action Methods to Understand Conflicts in End-of-Life Care

Empathy is a core feature of patient-centered care. It enables practitioners to better understand the patient and family concerns that are key to patient and family satisfaction, prevention of anxiety and depression, and provider empowerment. Current methods of teaching communication skills do not specifically focus on enhancing the ability to “stand in the patient's shoes” as a way of connecting with the patient and/or family experience and understanding feelings that may be a source of conflict with providers. In this paper, we present a model for deepening empathic understanding based upon action methods (role-reversal and doubling) derived from psychodrama and sociodrama. We describe these techniques and illustrate how they can be used to identify hidden emotions and attitudes and reveal that which the patient and family member may be thinking or feeling but be afraid to say. Finally, we present data showing that these methods were valuable to participants in enhancing their professional experience and skills

Chapter 06: restricted

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Chapter 14: Final Thoughts on Institutional Change and a ‘Job that Is Not My Life”

In this chapter, Dr. Baile talks about anticipating retirement and shares some final thoughts about MD Anderson. He notes that he is now in a “letting go processes” and wonders about the fate of the iCARE program he build, given the powerful effect of shifting institutional priorities. He notes how pleased he is that he has helped many people and has far exceeded what he believed he would do, though he does not want to continue to practice in the current institutional environment. He tells an anecdote to illustrate current culture, then offers some final words on his career a MD Anderson.https://openworks.mdanderson.org/mchv_interviewchapters/1420/thumbnail.jp

Chapter 02: Early Education and a Transformational Experience in Italy

Dr. Baile begins by describing the educational experiences and support he received at Catholic elementary and preparatory schools. He notes that he was a “late bloomer” and did not have the advantage of a family background of scholarship: he had to “make it on his own,” he says. He talks about choosing to major in psychology at St. Peter\u27s College (Jersey City, NJ; BA conferred 1966) and how, in his junior year, he met Angelo Dannizino who encouraged him to apply to medical school, which led him to the University of Pavia School of Medicine in Pavia, Italy, (MD conferred, 1972). Italy provided him with a “transformational” experience. He discusses the impact of living and studying in Italy and notes that he has sustained his friendships in Italy and travels back there to conduct workshops on communication.https://openworks.mdanderson.org/mchv_interviewchapters/1408/thumbnail.jp

Walter Franklin Baile, MD, Oral History Interview, October 25, 2016

Major Topics Covered: Psychiatry at MD Anderson Developing communications teaching at MD Anderson The iCare communications program: services, institutional support for Institutional change with shift in administration, 2011 and Ronald DePinhohttps://openworks.mdanderson.org/mchv_interviewsessions/1068/thumbnail.jp

Chapter 01: A Modest Middle Class Upbringing that Stressed Education

In this chapter, Dr. Baile talks about growing up in a white middle class neighborhood as one of five sons. He talks about his father (Franklin), a factory worker, the origin of the name Baile, and his amazement that his father was able to provide such a comfortable life on one income. He talks about his respect for unions and his father’s view that education offered a pathway to success. Next, he talks about his mother (Marie), raised by a very devoutly Catholic older sister. He talks about what his daughter, Danielle, is currently doing in college. He briefly discusses his own interest in photography and his plans to pursue photography once retired.https://openworks.mdanderson.org/mchv_interviewchapters/1407/thumbnail.jp

Walter Franklin Baile, MD, Oral History Interview, September 01, 2016

Major Topics Covered: Psychiatry at MD Anderson Developing communications teaching at MD Anderson The iCare communications program: services, institutional support for Institutional change with shift in administration, 2011 and Ronald DePinhohttps://openworks.mdanderson.org/mchv_interviewsessions/1067/thumbnail.jp

Chapter 13: Reflections on Communications

Dr. Baile begins this chapter by listing the accomplishments he is really proud of, then sets his work on communications in the context of a changing institution. He explains that he has seen advances in research and treatment options, but not corresponding advances in the people side of medicine. He notes that leaders can serve as models to promote these advances. He then shares his own thought process as he looks at his own career, wondering “have I failed at not making this a priority?” He discusses a 2014 institutional initiative, “The Language of Caring” that failed, noting that the faculty was too busy to take part and advance it.https://openworks.mdanderson.org/mchv_interviewchapters/1419/thumbnail.jp