Table 5.

Barriers to Incorporating Prognosis in the Care of Older Adults

Barrier	Example
Uncertainty in predicting long-term prognosis	“[There is] the uncertainty that no one really knows what someone’s life expectancy is going to be.”
Difficulty in discussing prognosis	“I think we should be talking about [prognosis] more, definitely…I think it’s just really difficult to talk about.”
Inadequate training	“We’ve not been given great training about prognosis.”
Concern about patient reactions	“I’m afraid that the patients will think I’m giving up on them, like, I’m not doing everything I can.”
Time constraints	“We often think [prognosis] is something we ought to talk about but if I open this conversation I’m going to get behind and I’ve got many more other people to see today, so I’m not going to bring it up.”
Lack of value placed on prognosis in societal or health care culture	“It is kind of a stigma—we are supposed to be helping people to live a healthy life and probably not so much talking about life span.”
Competing practice incentives	“There are so many things pulling primary care doctors in different ways…I need to have my 85-year-olds’ A1cs below 7 to get my bonus this year…when that really doesn’t help my patients long term.”
Concern for litigation	“If the patient sued you or some legal thing happened we often worry about that….You could write in your note: ‘I discussed with patient, reviewed prognosis indicator…it said less than this number,’ but I don’t know if that would protect you if something bad happened.”