"For patients who remember having such conversations, there are powerful
positive effects," says researcher Alexi Wright, MD, a medical oncology
fellow at the Dana-Farber Cancer Institute in Boston.
The findings were presented at the annual meeting of the American Society of
The study involved 332 cancer patients who eventually died; just over
one-third recalled having end-of-life discussions with their doctors.
Wright says she cannot say with certainly what was actually discussed.
"But since the patients who recalled these discussions had a significantly
better understanding of their illness, I can surmise that the conversation
included talking about their poor prognosis," she says.
Patients More Likely to Reap Hospice Benefits
Compared with patients who did not recall having end-of-life discussions
with their doctors, those who did:
Were 1.6 times more likely to enter a hospice in time to receive its
benefits -- that is, to die as comfortable a death as possible. In the study,
people who entered the hospice two months or more before death reported the
best quality of life in their final weeks, Wright says.
Were three times more likely to complete a do-not-resuscitate order and two
times more likely to fill out a living will.
Were no more likely to meet criteria for depression.
Were no more likely to report being depressed, worried, anxious, or
terrified when directly asked.
Patients who didn't recall talking to their doctor were more likely to be
admitted to the ICU, to be placed on a ventilator, or to undergo resuscitation,
People who received aggressive care generally reported worse quality of
life, she tells WebMD.
"It's important for cancer patients with advanced cancer to talk to
their doctors about the kind of care they want to receive," Wright says.
"Your physical health can change suddenly, so have the discussion when
you're still relatively healthy."
Taking to Your Doctor About End-of Life-Care
Barbara Murphy, MD, director of the pain and symptom management program at
the Vanderbilt-Ingram Cancer Center in Nashville, Tenn., says patients with
advanced cancer may sometimes need to take the initiative.
"Some doctors find it difficult to have discussions about a grave
prognosis with their patients. But it's their job," she tells WebMD.
Murphy says it's important to know if you are terminally ill so that you can
use the information in your decision-making.
"We don't know what patients want to do if they have six months to live.
Some might want to go to Florida and visit their grandchildren, and others
might want to be in a phase I study," Murphy says.
That said, there is a small percentage of patients who rather not know,
"and react tearfully, angrily or even turn on the physician, as the
messenger," she says.