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End-of-life discussions were beneficial for patient, caregiver
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Despite concerns that end-of-life discussions between the physician and patient may cause psychological harm, recent research suggested these discussions are beneficial for both the patient and caregiver.
“We found no evidence that [end-of-life discussions] were significantly associated with increased emotional distress and psychiatric disorders,” the researchers wrote. “Instead, the worst outcomes were seen in patients who did not report having these conversations.”
In a multisite, prospective, longitudinal cohort study, researchers from various institutions in Massachusetts followed 332 patients with advanced cancer and their caregivers from study enrollment to death (median of 4.4 months). Psychiatric illness and quality of life for bereaved caregivers were assessed at a median of 6.5 months.
One hundred twenty-three patients (37%) reported having end-of-life discussions; these discussions were not associated with higher rates of depression (OR=1.33; 95% CI, 0.54-3.32) or worry (P=.19).
End-of-life discussions were associated with decreased rates for ventilation (OR=0.26; 95% CI, 0.08-0.83), resuscitation (OR=0.16; 95% CI, 0.03-0.80), ICU admission (OR=0.35; 95% CI, 0.14-0.90) and earlier hospice enrollment (OR=1.65; 95% CI, 1.04-2.63).
Results indicated more aggressive medical care was associated with worse patient quality of life (P=.01) and a higher risk for a major depressive disorder among bereaved caregivers (OR=3.37; 95% CI, 1.12-10.13).
Longer hospice stays were associated with better patient quality of life (P=.01); better patient quality of life was associated with better caregiver quality of life (P=.001).
The researchers suggested these findings be interpreted in an observational study in which patients with terminal cancer could not be randomly assigned to end-of-life discussions for ethical and logistical reasons. – by Jennifer Southall
JAMA. 2008; 300:1665-1673.
If there were physicians who wondered about the impact of end-of-life discussions on patients' psychological distress, this study helps debunk the myth. Oncologists should offer patients the opportunity to discuss options such as hospice and palliative care in addition to chemotherapy as part of the informed consent for their treatment.
– Biren Saraiya, MD
Assistant professor, University of Medicine and Dentistry, NJ