In last week's Science section of the NYTimes, Denise Grady reported on a recent study in which most of the doctors who responded to a survery indicated they would wait until their terminally ill patients felt worse or were out of options before talking about end-of-life care, such as hospice.
I was moved to write a letter to the editor (p.D4 or click here) when I read one of the possible reasons cited: fear that patients will lose hope or that physicians will “yank away” hope by talking about end-of-life wishes.
End-of-life discussions are opportunities for clinicians to teach patients about hope in the setting of terminal disease. In particular, patients need to know that they can expect one outcome while, at the same time, hoping for another outcome. This is called "hopeful acceptance" or "acceptance with hope."
And patients must be reassured that they can change their hopes and wishes at any time. Voicing them with their physicians does not carve them in stone.
Throughout survivorship, physicians should discuss patients' hopes. Because, as I said in the letter, "From diagnosis to death, by helping patients benefit from both hope and the best modern medicine has to offer, physicians help patients live until they die."