Understanding Hospice Patients’ Beliefs About Their Life Expectancy: A Qualitative Interview Study

BACKGROUND Patients with advanced disease often overestimate their life expectancy, which potentially impacts decision making. OBJECTIVE To examine the nature and source of hospice patients' life expectancy estimates, about which little is known. DESIGN Using semi-structured interviews, patients were asked to estimate their life expectancy and elaborate on their response. SETTING/SUBJECTS Participants were hospice patients (n = 20, 55% male; 60% cancer). MEASUREMENT We conducted thematic analysis using open and focused coding. RESULTS Many participants had difficulty answering the life expectancy question and expressed uncertainty about when they would die. One-third overestimated their length of life relative to actual survival. The most common source of patients' prognostic beliefs was knowledge about their body, including physical symptoms and change over time. Half of patients reported that a provider had given them a prognostic estimate, and one-third agreed with, or gave estimates consistent with, the provider's estimate. Some patients said providers do not know prognosis or that time of death was unknowable. CONCLUSIONS Key findings were that 1) many hospice patients had difficulty estimating life expectancy, and 2) hospice patients' life expectancy estimates were frequently based on their body and not on information from medical providers. These findings have implications for measuring prognostic awareness, as valid assessment is a necessary component of determining whether prognostic awareness is beneficial for patients. Future research should examine how life expectancy estimates are associated with well-being and whether results extend to larger samples of patients with advanced disease not in hospice.