Give It to Me Straight, Doc! End-of-Life Discussions may be Empowering

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straightforward end-of-life discussions can be empowering for terminally ill
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Some doctors fear that giving their patients bad news will trigger negative consequences. But a study published in the Aug. 1, 2012 Journal of Clinical Oncology found that most patients don't respond the way doctors think they might.

The study debunks many long-held myths that can prevent doctors from initiating end-of-life discussions with terminally ill cancer patients.

Dr. Jennifer Mack of the Dana-Farber Cancer Institute found in a similar study published in the New England Journal of Medicine, when doctors initiated end-of-life discussions early on with their advanced cancer patients, those patients were more likely to get care consistent with their wishes.

Yet, on average, such discussions would take place about one month before a patient died, if they took place at all.

Patients who have end-of-life discussions were no more depressed or worried after getting bad news than other patients, pointed out Thomas J. Smith, a medical oncologist, director of palliative medicine at Sidney Kimmel Comprehensive Cancer Center and professor of oncology at Johns Hopkins Medical School in Baltimore. Smith has written related editorials that accompanied both studies.

Rather, patients who had end-of-life discussions with their doctor felt empowered to choose less aggressive medical care and opt for more and earlier hospice enrollment instead.

Smith believes that these findings support earlier research showing that an honest end-of-life discussion doesn’t diminish hope or cause most patients to feel offended or betrayed. More importantly, it doesn’t decrease their survival. In fact, many of these patients enjoyed a better quality of life.

What it does do, wrote Smith, is allow terminally ill patients “to plan advance directives, plan trips, get their financial concerns in order, resolve family issues and make spiritual peace before they get too sick.”

These patients were also better able to take advantage of hospice, palliative care and decide the terms of their final days, said Smith.

As a patient or caregiver, what can you do if your doctor doesn’t initiate such a conversation?

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