Patients Benefit From End-of-Life Discussions With a Doctor

By Amanda Gardner
HealthDay Reporter
Tuesday, October 7, 2008; 5:00 PM

Copyright © 2008 ScoutNews, LLC. All rights reserved.

TUESDAY, Oct. 7 (HealthDay News) -- End-of-life discussions between a doctor and a terminally ill patient do not result in more distress for patients. In fact, they result in less aggressive medical interventions and enhanced quality of life in a patient's final days, a major new study found.

"For the past two decades, the debate has been around when, whether and how to have end-of-life conversations, but it wasn't clear if it was worth it," said study lead author Dr. Alexi A. Wright, a hematology-oncology fellow and research scholar at the Center for Psycho-Oncology and Palliative Care Research, both at Dana-Farber Cancer Institute in Boston. "This study is the first to look at outcomes and quality of life."

"A lot of doctors are afraid they will rob patients of hope if they have these conversations," Wright added. "But there's the possibility that the patient may be robbed of the opportunity to make informed decisions and live the life they want."

Experts had been concerned that such conversations might increase a patient's despondency and anxiety. This left doctors and other health-care providers relying heavily on avoidance tactics.

For the new study, the researchers interviewed 332 pairs of dying patients -- all of whom had advanced cancer -- and their informal caregivers. The median time from enrolment in the study to death was 4.4 months. The caregivers' psychological state and quality of life was assessed about 6.5 months after the patient's death.

At the start of the study, 37 percent of the patients said they'd had end-of-life discussions with their doctor. Contrary to expectations, these talks did not increase the rates of depression or worry.

And those patients who did have such talks with their physician had lower rates of ventilation (1.6 percent versus 11 percent); resuscitation (0.8 percent versus 6.7 percent) and admission to the intensive care unit (4.1 percent versus 12.4 percent). These patients also enrolled in a hospice earlier; longer hospice stays were associated with better quality of life, while aggressive medical care had the opposite effect, the study found.