Seriously ill patients undergoing hemodialysis are more optimistic about their prognosis and prospects for transplants than their nephrologists, according to a study published online by JAMA Internal Medicine. The study also found that nephrologists rarely had discussed estimates of life-expectancy with their patients.
Melissa W. Wachterman, M.D., M.P.H., from Veterans Affairs Boston Health Care System and colleagues compared patients' and physicians' expectations about one- and five-year survival rates and transplant candidacy among 207 patients undergoing hemodialysis through medical record reviews and interviews. "Among the 62 interviewed patients, no patients reported that their nephrologist had discussed an estimated life expectancy with them, and the nephrologists reported that they had done so for only two interviewed patients," the authors found. The nephrologists reported that "-for 60 percent of patients, they would not provide any estimate of prognosis even if their patient insisted." The authors note that patients' expectations about one-year survival rates are fairly accurate, but that patients over-estimate their long-term survival rates.
"As our ability to accurately prognosticate for seriously ill patients continues to advance, developing interventions to help providers communicate effectively with patients about prognosis will become increasingly important," the authors conclude.
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