Discussions about end-of-life can benefit patients and their families in dramatic ways. Unfortunately, the emotional discomforts for both physicians and patients often serve as insurmountable obstacles to initiating these important discussions.
A study at the Dana-Farber Cancer Institute and reported in JAMA may help.
Looking only at patients with advanced cancer, researchers explored the associations between end-of-life discussions and patient mental health, medical care near death and caregiver bereavement adjustment. You can meet the lead author, Dr. Alexi Wright on this 2-minute video.
Here are some findings from the study, paraphrased for ease of blogging:
- Less aggressive care at the end of life was associated with better quality of life for patients.
- The earlier patients began hospice, the better their quality of life at the end of life.*
- The better the patients' quality of life near death, the better the survivors fared after the death.
In light of these findings, less aggressive care and early referral to hospice can be considered proactive steps in the pursuit of high quality care at the end-of-life (and not as "giving up.") When combined with hopeful acceptance (as explained in this letter to NYTimes), physicians and their patients may feel more comfortable initiating and pursuing timely end-of-life discussions with patients.
Planning for end-of-life care is emotionally trying. What's more trying is dealing with end-of-life when you haven't planned for end-of-life care.
[*as long as patients entered hospice at least a week before death.]