Knowledge of imminent death did not increase pain, anxiety

Lundquist G. J Clin Oncol. 2011;10.1200/JCO.2011.34.6247.

Issue: October 10, 2011

Those patients who were made aware of imminent death during cancer treatment at the end-of-life did not experience more pain or anxiety in comparison to patients who were unaware of death, according to data from a Swedish study.

Instead the knowledge provided patients with more time to prepare their family and circumstances for death.

The study included all patients with cancer from the Swedish Register for Palliative Care between 2006 and 2008 where patients were still able to make decisions within hours of days before death. Data from just 1,191 of these patients was matched to and then compared with 1,191 patients who were not informed of imminent death.

There were no significant differences in registered symptoms such as pain, anxiety, and nausea, identified between the two groups. Informed patients did have PRN drugs prescribed significantly more frequently.

In addition, those patients informed of imminent death were significantly more likely to have died in their preferred location (70% vs. 39%; P<.001), to have had bereavement support offered (83% vs. 78%; P<.001) and to have had their family informed about imminent death (98% vs. 89%; P<.001).

The researchers indicated that data from this study point to a "positive effect associated with providing accurate and timely end-of-life information."

This is a study where registry data included details such as "whether the patient had been informed of imminent death by MD, Nurse, both or none." The data are potentially biased as the registry data is completed by large number of palliative care personnel (more than 90% of patient had been told of the imminent death). Regardless the implications are important for clinical practice. Patients who knew of the imminent death, died where they wanted to and likely with less symptoms. This is the outcome we all strive for. To serve our patients properly, I would suggest that since no one knows when death is imminent, tell your patients of potential life threatening illness and help them prepare for life events that matter to them (telling their loved ones things that matter, devise a legal care plan for their young children if a single parent, traveling or having family events that are on their "bucket list"). What is not reported is what was actually conveyed to the patients. Here is what I consider a classical article on how to have the conversation by Timothy Quill.

– Biren Saraiya, MD
HemOnc Today Editorial Board member

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