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?
“Don’t be afraid to ask for information—in fact insist on it,” Smith writes. “If your doctor is vague ask him or her: ‘Help me understand from a planning perspective what to expect over the next six months or a year.’”
Of course, bad news is never easy to hear, but it can come as a relief, Smith said. “A lot of times terminal cancer patients will say, ‘that’s bad, but it’s a lot better than I expected.’”
The bottom line: The more patients know, the more likely they can establish realistic goals for pain management, whether to continue treatment and determine how to spend what time they have left, he added.
Lynette Summerill is an award-winning writer and Scuba enthusiast who lives in San Diego with her husband and two beach loving dogs. In addition to writing about cancer-related issues for EmpowHER, her work has been seen in publications internationally.
Sources:
American Society of Clinical Oncology Statement: Toward individualize care for patients with advanced cancer. JM Peppercorn, TJ Smith, PR Helft, DJ Debono, SR Berry, DS Wollins, DM Hayes, JH Von Roenn, LE Schnipper, American Society of Clinical Oncology. J Clin Oncol. 2011 Feb 20;29(6):755-60. doi: 10.1200/JCO.2010.33.1744. Epub 2011 Jan 24. (abstract via PubMed) http://www.ncbi.nlm.nih.gov/pubmed/21263086/
Study shows importance of early End-of-life Discussions. National Cancer Institute Bulletin Nov 23, 2012, vol9/no.22. page 2
http://www.cancer.gov/ncicancerbulletin/111312/page2
A Conversation with Dr. Thomas Smith on the Growing Role of Palliative Care for Patients with Cancer. National Cancer Institute Bulletin, March 20, 2012, vol.9/no.6
http://www.cancer.gov/ncicancerbulletin/032012/page4
Talking to Patients About Dying. (Editorial) Thomas J. Smith and Dan L. Longo, M.D. N Engl J Med 2012; 367:1651-1652 October 25, 2012DOI: 10.1056/NEJMe1211160 and
Johns Hopkins New Release. Prescription for Palliative Care: Four Points to Improve Discussions about Dying. 25 Oct. 2012.
http://www.hopkinsmedicine.org/news/media/releases/prescription_for_palliative_care_four_points_to_improve_discussions_about_dying
Reviewed May 28, 2013
by Michele Blacksberg RN
Edited by Jody Smith