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Doctors Delay End-of-Life Talks

By January 14, 2010

A recent study in the journal Cancer shows that many doctors delay discussions about end-of-life.  Guidelines for physicians generally state that doctors should begin end-of-life discussions when it appears the patient has a year or less to live.  That way, patients can begin to think about how and where they want to die and have time to make necessary arrangements and get their affairs in order.  The study in Cancer revealed that despite those guidelines, many doctors delay end-of-life talks.

The study asked physicians who cared for cancer patients to imagine one of their patients had 4-6 months to live but felt generally well.  Then they asked them what topics of discussion they would have with the patient at this time.  Of the 4,074 doctors surveyed, 65% said they would discuss the patient's prognosis but only 44% said they would discuss resuscitation, 26% said they would discuss hospice, and 21% would discuss site of death.

I'm very discouraged by these results but not entirely surprised.  So many physicians view death as a failure instead of a natural, though sad, part of life.  Physicians may feel like they would be crushing a patients hope if they discussed death too soon but neglect to think of how their actions could negatively impact the patients final days.

Patients who aren't told their prognosis nor presented with all their options are more likely to go along with whatever the physician recommends, which is often treatment after treatment and one hospital admission after another.  They are denied precious time that could be used to prepare for death and say goodbye.  They are often denied the basic right of choosing how and where they want to die.

The statistic that stands out to me in this study is the percentage of physicians that would discuss hospice care with their patient.  This patient has less than 6 months to live, which is a clear indicator that a hospice discussion is appropriate.  I personally feel like it should be mandatory for physicians to discuss the option of hospice with their patients who have 6 months or less to live.  It would be medical negligence to neglect to tell a patient about a treatment that could save their life.  It's also negligent, in my opinion, to not tell a patient about a treatment that could dramatically improve the quality of the life they have left.

California is currently the only state in the nation that has a law requiring physicians to discuss all treatment options with terminally ill patients.  The California Terminal Patient's Right to Know Act was passed in 2008 and requires full disclosure of all available treatment options to terminally ill patients, including hospice care.

What do you think?  Should doctors be required to tell their patients with 6 months or less to live about hospice care?

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