Doctors can talk frankly to terminally ill w/o distressing them

[cougarnurse]

From Wall Street Journal: Health Blog : Doctors Can Talk Frankly to Terminally Ill Without Distressing Them

What do you say to someone who’s dying? Is it better to hold out hope for a last-minute cure no matter how unlikely or to acknowledge that the end is near and say goodbye?

That issue faces not just families but also physicians who treat terminally ill patients. Some doctors communicate more honestly with family members than the sick, sticking to euphemisms with patients out of fear of depressing them.

But a study published in the current issue of JAMA found that terminally ill patients who had end-of-life discussions with their doctors didn’t experience more emotional distress than patients who didn’t have such talks.

Researchers at Dana-Farber Cancer Institute in Boston studied 332 patients with advanced cancer and their caregivers at seven different outpatient sites around the country. Besides experiencing no higher rates of major depressive disorders or worry, those 123 patients who reported having end-of-life discussions with their doctors were less likely to have had aggressive medical care during their last week of life and were admitted to hospices earlier.

The researchers acknowledge that it’s possible that patients who preferred less aggressive medical care might have been more likely to start end-of-life discussions with their doctors.

The study also had another important limitation: When they were interviewed for the study, the terminally ill patients were asked, “Have you and your doctor discussed any particular wishes you have about the care you would want to receive if you were dying?” (emphasis ours)

So the talks might have been hypothetical — quite different than discussing that patient’s own imminent death. The authors concede that they don’t know who initiated the conversations, when they occurred or what was said. “Unfortunately, end-of-life are often poorly documented in the medical record, and other studies have revealed that patients and caregivers recall of conversations are often discrepant,” the authors write.