AP/Houston Chronicle Examines Physician Discussions Regarding End-of-Life Issues

Main Category: Primary Care / General Practice
Also Included In: Palliative Care / Hospice Care;  Psychology / Psychiatry
Article Date: 18 Jun 2008 - 9:00 PDT

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The AP/Houston Chronicle on Sunday examined how although many physicians avoid telling patients that a condition has become terminal because they believe "they are doing patients a favor by keeping hope alive," such discussions might be beneficial to the patient.

A federally funded study presented earlier this month at the annual American Society of Clinical Oncology conference found that one-third of terminally ill cancer patients said their physician had discussed end-of-life care with them. However, the study found that patients of physicians who had discussed palliative care were no more depressed and were more likely to spend their final days outside the hospital and avoid the costs of futile care.

Barbara Coombs Lee, president of the advocacy group Compassionate Choices, said some physicians believe conversations about chances of survival will harm patients but "people crave these conversations, because without a full and candid discussion of what they're up against and what their options are, they feel abandoned and forlorn; as though they have to face this alone." John Marshall, a physician at Georgetown University's Lombardi Comprehensive Cancer Center, said patients who are told that their condition has become terminal are better able to plan for a "good death" and make decisions, such as do-not-resuscitate orders. According to Anthony Lee Back, a physician at the Fred Hutchinson Cancer Center, regarding ethics, "it's easy -- patients ought to know." Speaking at the ASCO conference, Lee Back said, "Talking about prognosis is where the rubber meets the road. It's a make-or-break moment -- you earn that trust or you blow it."

ASCO President and Johns Hopkins University cancer specialist Nancy Davidson said it is "distressing if it's true" that only one-third of patients are told when their disease becomes terminal, adding, "It says we have a lot of homework to do" (Marchione, AP/Houston Chronicle, 6/15).

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