Discussing End-of-Life Care May Improve Quality of the Life That's Left
By Todd Neale
BOSTON, 19 oct 2008--Discussions about end-of-life care appear to benefit terminally ill cancer patients and their caregivers alike, researchers here found. Cancer patients who spoke with their physicians about their expectations for medical care near death did not have higher rates of depression or anxiety and were less likely to receive aggressive medical care compared with patients who did not have such discussions, Alexi Wright, M.D., of Dana-Farber Cancer Institute, and colleagues reported in the Oct. 8 issue of the Journal of the American Medical Association. More aggressive medical care in the week before death was associated with worse patient quality of life (P=0.01) and a higher risk of major depressive disorder among caregivers (OR 3.37, 95% CI 1.12 to 10.13), the researchers said.
They also found that patients who had discussed end-of-life issues enrolled earlier in hospice care, which was associated with improved patient quality of life (P=0.01); that, in turn, was associated with improved quality of life for caregivers after the patient had died (P=0.001).
"Given the adverse outcomes associated with not having end-of-life discussions," the researchers said, "there appears to be a need to increase the frequency of these conversations. By acknowledging that death is near, patients, caregivers, and physicians can focus on clarifying patients' priorities and improving pain and symptom management."
Although it has been suggested that discussing end-of-life issues may cause psychological distress in patients as they near death, no studies have examined the issue, according to the researchers.
So they prospectively evaluated 332 terminally ill cancer patients (mean age 57.9; 55.1% male) and their caregivers at seven U.S. centers until a median of 6.5 months after the patients had died. The patients were participating in the Coping with Cancer study.
Patients lived for a median of 4.4 months after study enrollment.
Overall, 123 (37%) of the patients reported having a discussion about end-of-life care with their physicians.
Those patients did not have an increased risk of major depressive disorder (OR 1.33, 95% CI 0.54 to 3.32), generalized anxiety disorder (OR 2.50, 95% CI 0.51 to 12.1), or other mental disorders compared with patients who did not have an end-of-life conversation with their physicians.
Patients who had talked about end-of-life care were more likely to accept that their illness was terminal (52.9% versus 28.7%), to prefer treatment for easing pain rather than extending life (85.4% versus 70%), and to have completed a do-not-resuscitate order (63% versus 28.5%). All were significant at P<0.001. p="0.01)," p="0.004)," p="0.02)," p="0.04)," p="0.001)" p="0.002)">
Primary source: Journal of the American Medical AssociationSource reference:Wright A, et al "Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment" JAMA 2008; 300: 1665-1673.
They also found that patients who had discussed end-of-life issues enrolled earlier in hospice care, which was associated with improved patient quality of life (P=0.01); that, in turn, was associated with improved quality of life for caregivers after the patient had died (P=0.001).
"Given the adverse outcomes associated with not having end-of-life discussions," the researchers said, "there appears to be a need to increase the frequency of these conversations. By acknowledging that death is near, patients, caregivers, and physicians can focus on clarifying patients' priorities and improving pain and symptom management."
Although it has been suggested that discussing end-of-life issues may cause psychological distress in patients as they near death, no studies have examined the issue, according to the researchers.
So they prospectively evaluated 332 terminally ill cancer patients (mean age 57.9; 55.1% male) and their caregivers at seven U.S. centers until a median of 6.5 months after the patients had died. The patients were participating in the Coping with Cancer study.
Patients lived for a median of 4.4 months after study enrollment.
Overall, 123 (37%) of the patients reported having a discussion about end-of-life care with their physicians.
Those patients did not have an increased risk of major depressive disorder (OR 1.33, 95% CI 0.54 to 3.32), generalized anxiety disorder (OR 2.50, 95% CI 0.51 to 12.1), or other mental disorders compared with patients who did not have an end-of-life conversation with their physicians.
Patients who had talked about end-of-life care were more likely to accept that their illness was terminal (52.9% versus 28.7%), to prefer treatment for easing pain rather than extending life (85.4% versus 70%), and to have completed a do-not-resuscitate order (63% versus 28.5%). All were significant at P<0.001. p="0.01)," p="0.004)," p="0.02)," p="0.04)," p="0.001)" p="0.002)">
Primary source: Journal of the American Medical AssociationSource reference:Wright A, et al "Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment" JAMA 2008; 300: 1665-1673.
1 comment:
It's true. Talking helps. Yes, those first few words are the scariest, but then it becomes freeing--empowering.
My mom was able to do it in an almost third person way--she was able to talk about how she wanted things--what she'd kind of imagined, or wished she had done differently for my dad.
I also added my thoughts about my own eventual passing. I think it took the focus off her.
I was able to give my mom a home passing--and I did all I could to honor her wishes.
~Carol O'Dell
Author of Mothering Mother: A Daughter's Humorous and Heartbreaking Memoir
available on Amazon
www.mothering-mother.com
Post a Comment