Doctors Put Off End-of-Life Talks With Terminally Ill

Frank conversations about hospice and preferred place of death are often needed, experts say

By Jennifer Thomas
HealthDay Reporter

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TUESDAY, Jan. 12 (HealthDay News) -- Terminally ill patients have much to consider, from whether they want to die at home or in the hospital to whether they want doctors to continue aggressive treatment or focus on making them comfortable during their final weeks or months.

Yet those difficult, emotional conversations aren't happening nearly as often, or as early, as they ought to be, say researchers who surveyed a national sample of almost 4,100 physicians who treat cancer patients.

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Given a hypothetical example of a cancer patient with four to six months to live but who was still feeling well, 65 percent said they would discuss a prognosis. But only 26 percent of doctors said they would discuss hospice with the patient, 21 percent said they would discuss where the patient would like to die and only 44 percent said they would discuss resuscitation preferences.

Instead, some doctors said they would wait until the patient was feeling worse or until there were no more treatment options. That runs counter to current guidelines, which recommend having end-of-life discussions when patients have less than a year to live.

"There are guidelines out there that say if patients are terminal and have a year to live, they should get some information about options for improving the quality of their death," said lead study author Dr. Nancy Keating, associate professor of medicine and health care policy at Brigham and Women's Hospital and Harvard Medical School. "This includes their DNR [do not resuscitate] status, hospice enrollment and where they would prefer to die. Most doctors don't talk to their patients about these things until later than is recommended."

The study will be published in the Jan. 11 online edition of the journal Cancer.

There are many reasons why doctors aren't having these discussions as often as they should, said Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society. The conversations can be time consuming and emotionally wrought.

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