It's the toughest conversation in medicine: "You're going to die." Yet when doctors are forthright with their patients about terminal illness and discuss end-of-life issues, the quality of the patient's life and the lives of their loved ones often improves, according to a study published today in the Journal of the American Medical Assn.
The study conclusions were drawn from interviews with 332 patients and their caregivers. After the patient died, investigators reviewed the patient's medical records and interviewed a spouse or family member. Researchers found that patients who discussed end-of-life care with their doctors did not suffer any increased emotional distress because of the frank conversation. Compared with patients who did not have end-of-life discussions with their doctors, the patients were more likely to accept that their illness was terminal and consent to comfort care rather than aggressive, life-extending therapies. They were more apt to enroll earlier in hospice programs, and their family members coped better with their deaths. Family members whose loved ones died in intensive care units were more much likely to be depressed compared with those whose loved ones didn't receive intensive care before death.
Experts on end-of-life care urge doctors, patients with terminal illness and family members to have a conversation about what kind of care the patient wants to receive in the final stage of life, says Dr. Alexi Wright, the study's lead author and a hematology-oncology fellow at Dana-Farber Cancer Institute in Boston.
"I still take a deep breath before I start an end-of-life conversation," Wright said. "We all wish we had different answers and better news, but it's important for us to be both frank and empathetic to give patients and families a chance to prepare for death."
-- Shari Roan