End-of-Life Discussions May Ease Dying

Patients Who Recall End-of-Life Discussions With Their Doctors More Likely to Die Comfortably
By Charlene Laino

June 4, 2008 (Chicago) -- Would you want to know if you only had six months to live?

It's a question no one really wants to face, but new research suggests that patients who recall having end-of-life conversations with their doctors may go more gently into the night.

"For patients who remember having such conversations, there are powerful positive effects," says researcher Alexi Wright, MD, a medical oncology fellow at the Dana-Farber Cancer Institute in Boston.

The findings were presented at the annual meeting of the American Society of Medical Oncology.

The study involved 332 cancer patients who eventually died; just over one-third recalled having end-of-life discussions with their doctors.

Wright says she cannot say with certainly what was actually discussed. "But since the patients who recalled these discussions had a significantly better understanding of their illness, I can surmise that the conversation included talking about their poor prognosis," she says.

Patients More Likely to Reap Hospice Benefits
Compared with patients who did not recall having end-of-life discussions with their doctors, those who did:

* Were 1.6 times more likely to enter a hospice in time to receive its benefits -- that is, to die as comfortable a death as possible. In the study, people who entered the hospice two months or more before death reported the best quality of life in their final weeks, Wright says.
* Were three times more likely to complete a do-not-resuscitate order and two times more likely to fill out a living will.
* Were no more likely to meet criteria for depression.
* Were no more likely to report being depressed, worried, anxious, or terrified when directly asked.

Patients who didn't recall talking to their doctor were more likely to be admitted to the ICU, to be placed on a ventilator, or to undergo resuscitation, Wright says.

People who received aggressive care generally reported worse quality of life, she tells WebMD.

"It's important for cancer patients with advanced cancer to talk to their doctors about the kind of care they want to receive," Wright says. "Your physical health can change suddenly, so have the discussion when you're still relatively healthy."

Taking to Your Doctor About End-of Life-Care
Barbara Murphy, MD, director of the pain and symptom management program at the Vanderbilt-Ingram Cancer Center in Nashville, Tenn., says patients with advanced cancer may sometimes need to take the initiative.

"Some doctors find it difficult to have discussions about a grave prognosis with their patients. But it's their job," she tells WebMD.

Murphy says it's important to know if you are terminally ill so that you can use the information in your decision-making.

"We don't know what patients want to do if they have six months to live. Some might want to go to Florida and visit their grandchildren, and others might want to be in a phase I study," Murphy says.

That said, there is a small percentage of patients who rather not know, "and react tearfully, angrily or even turn on the physician, as the messenger," she says.

SOURCES:
American Society of Clinical Oncology 44th Annual Meeting, Chicago, May 30-June 2, 2008.

Alexi Wright, MD, medical oncology fellow, Dana-Farber Cancer Institute, Boston.

Barbara Murphy, MD, director, pain and symptom management program, Vanderbilt-Ingram Cancer Center, Nashville, Tenn.

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