Appendix B.

Patient life expectancy assessment survey questionnaire

1. Gender (Please circle one):	Male					Female
2. Occupation (Please circle one):
Attending physician	Resident					Medical student
	PGY1	PGY2	PGY3	PGY4	PGY5	Year 1	Year 2	Year 3	Year 4	Year 5
3. Number of years in practice:
4. Subspecialty, if any:
5. Where do you work primarily (Please circle one):
Community	Academic centre	Not working
6. Medical school:
7. Residency location:
8. Residency program (i.e., Internal, Urology, Family, etc):
9. Fellowship location:
10. Fellowship program:
For each of these scenarios, respondents were asked:
According to your clinical judgement, how many more years do you think this patient has to live? Number of Years left to live:
Clinical scenario 1				Clinical scenario 2
Patient is a 67 year old gentleman who was recently transferred from another hospital. His problem list includes ischemic and diabetic nephropathy, left nephrectomy for adenocarinoma of the kidney, angiodysplasia of the colon, abdominal aortic aneurysm repair with bypass and cholecystectomy, 70% stenosis of the left coronary artery, dyslipidemia, antibodies to Heparin with negative HITT assay, and GI hemorrhage due to ulcers. Medications include Norvasc 5mg PO OD, Metoprolol, 100mg PO BID, Pantoloc 40mg PO OD, Calcium 1g PO TID, Alprazolam 0.25 mg TID, Fenofibrate 1 capsule OD, Humulin N 26 units, Humulin R 14 units, Eprex 4000 units 3 times/week.				Patient is a 70 year old obese gentleman who presents with increasingly severe urinary tract obstructive symptoms. Past medical history includes two years of controlled type II diabetes, gout, and a hiatus hernia repair when he was 24 years old. Medications include Tolbutamide 500mg BID for his diabetes, Allopurinol, and Iron supplements.
Clinical scenario 3				Clinical scenario 4
Patient is a 54 year old gentleman who presents with recent chest pains lasting 45 minutes associated with diaphoresis, SOB, and presyncope. Patient was recently transferred from the psychiatric ward where he spent 11 days after being admitted with an overdose and suicidal tendencies. BP was elevated at 169/98, however the rest of the physical exam was unremarkable. Past medical history includes osteoporosis, osteoarthritis of the spine, coronary artery disease including stable angina and two past MIs 9 and 7 years ago, peripheral vascular disease, depression, and alcohol abuse for which he is practicing abstinence. Current medications include Cardizem 300mg BID, GTN (glyceryl trinitrate) patch 0.4mg x 12hr/day, enteric-coated Aspririn, and NSAIDs.				Patient is a 54 year old gentleman who presents with a gastric ulcer and a secondary lower GI bleed with a one month history of symptoms. The pain is dull, constant, present throughout, independent of meals, and often waking him at night. Recently, he has complained of increasing fatigue and weakness and noted 8 days of black stool with no visible blood. On physical exam, the liver was palpable 2 cm below the costal margin, and stool was positive for occult blood. The remainder was unremarkable. Past medical history includes alcohol abuse, hypertension, and chronic anxiety. Medications include Ranitidine 150 mg PO BID and Diltiazem SR 90 mg PO BID.
Clinical scenario 5				Clinical scenario 6
Patient is a 66 year old gentleman who presents with exertional dyspnea which he has had for the last 10 years but which has worsened significantly over the past 6 months. He was previously able to walk and carry wood without difficulty, but now becomes dyspneic from walking across the parking lot to the hospital. He has no symptoms of chest discomfort, no problems sleeping, and a normal stress test. In the past 6 months, he has had thrombosis of his left arm fistula formerly for dialysis, marked increase in gastroesophageal reflux symptoms, and marked right eye vision reduction which is under investigation. Past medical history includes LVH, CHF, an LAD angioplasty 6 years ago, a renal transplant 4 years ago, and severe hypertension. Medications include Cyclosporin, 100mg BID, Mycophenolate mofetil 500mg BID, Prednisone 5mg OD, Diltiazem 360mg OD, Atorvastatin 10mg OD, Cozaar 25mg OD, Nexium 40mg OD, Domperidone 10mg q6h, and Lasix 20mg OD.				Patient is a 69 year old gentleman who presents shortly after having had a total knee replacement following 10 years of osteoarthritic symptoms in his right knee. Physical exam was unremarkable. Past medical history includes 19 years of type II diabetes mellitus, appendectomy, and an operation for a bowel obstruction 54 years ago. Medications include Insulin, Tylenol 3, Coumadin, and Metamucil. Patient currently has Home Care physiotherapy and nursing support.
Clinical scenario 7
Patient is a 55 year old gentleman who presents with chest pain, diaphoresis, and shortness of breath after an exacerbation of asthma. These were ultimately relieved with sublingual Nitroglycerin and Ventolin. Other than use of accessory muscles on inspiration and a hyperinflated chest, physical exam was unremarkable. Cardiac workup was negative. There is no family history of hypertension, diabetes, or cardiovascular disease. The patient has a 20 pack-year smoking history but quit 6 years ago. Past medical history includes COPD with Reactive Airway Disease, Adult Respiratory Distress Syndrome, Aspiration pneumonitis, DVT. Medications include Theophylline 400mg PO BID, Coumadin 15mg PO OD, Nitroglycerin 0.3mg SL PRN, Salbutomol inhaler 2 puffs QID, Diltiazem 60mg PO QID.