For dying patients, early discussions about care reduce aggressive treatments
Terminally-ill patients who have discussions about end-of-life care earlier are less likely to have aggressive medical treatments in their final days, according to a Harvard study published in the Journal of Clinical Oncology. Instead, family and medical focus is more likely to shift to comfort care and honoring the patient's wishes.
"Aggressive care at the end of life for individual patients isn't necessarily bad, it's just that most patients who recognize they're dying don't want to receive that kind of care," Dr. Jennifer Mack, lead author, from the Dana-Farber Cancer Institute in Boston, told Reuters.
Reuters noted that treatment aimed at a cure or keeping patients alive typically costs more at the end of life and may not improve quality of life or comfort.
The Dartmouth Atlas of Health Care said that 32 percent of all Medicare spending is used to care for very sick patients during the last two years of life.
"We should at least consider having these discussions soon after diagnosis if we know that a patient has incurable cancer," Mack said.
"The last several decades have spawned intensive debate about whether aggressive medical treatment at the end of life results in unnecessary suffering," noted HealthDay reporter Randy Dotinga. "In the new study, said to be the first of its kind, researchers sought to understand whether the timing of discussions with patients about terminal illness made any difference in their care as they died."
The research, which involved 1,231 patients with advanced lung or colorectal cancer, found that nearly half received at least one type of aggressive end-of-life care such as chemotherapy or intensive care treatment. But those who had candid discussions about their end of life with physicians at least a month before they died were less apt to receive aggressive measures, and they were more likely to receive hospice care and to have that care offered earlier.
Hospice provides different forms of care aimed at comfort and quality of life, as opposed to curing an illness or prolonging life. Notes WebMD, "Hospice care provides medical services, emotional support and spiritual resources for people who are in the last stages of a serious illness, such as cancer or heart failure. Hospice care also helps family members manage the practical details and emotional challenges of caring for a dying loved one."
Hospice experts often lament that patients enter hospice care very late in a disease's progression and miss out on many of the benefits it provides.
The new study showed that nearly 90 percent of the patients did have end-of-life discussions, but for more than one-third they took place within 30 days of the patient's death. Two-thirds of the talks occurred in the hospital. And about half of patients received aggressive care.
When the discussions took place early, the patient was nearly seven times more apt to have hospice care.
Experts say that early discussion allows patients and families, as well as care providers, time to look at more options and better determine the circumstances they want as their illness progresses.
It is probable that earlier discussions allow patients to get the treatment they want as life winds down, Mack told HealthDay. "Patients who understand a poor prognosis are more likely to choose less aggressive care at the end of life. Not every patient wants palliative and less aggressive care, but most who recognize that they're dying want that."
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