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Archive for Monday, December 31, 2007

Doctors urged to discuss death

December 31, 2007

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— An Omaha researcher suggests more doctors need to talk to patients about plans for end-of-life care, although his recent study shows little direct evidence that planning ahead helps to prolong life.

"Generally, patients just aren't really comfortable (talking) about death," said Dr. Fausto Loberiza, a professor at the University of Nebraska Medical Center. "They come to the physician in the hope that they'll be cured."

He said patients are often too afraid to talk about the possibility of death at the same time they're exploring treatment options. And doctors should be trained to sensitively discuss living wills and advance health directives such as life support instructions with their terminally ill patients.

Loberiza's comments came as he and researchers at the Fred Hutchinson Cancer Research Center in Seattle released a study showing a relationship between advance health directives and death rates for cancer patients undergoing stem cell transplants. The findings ruled out a direct correlation.

"We thought our study would show there was no difference in survival whether there was an advance care plan or not, but that was not the case," Loberiza said. "We wanted to be able to show that advance care planning doesn't affect outcomes so it's OK to talk about."

The study, published Dec. 10 in the Journal of Clinical Oncology, found that transplant patients who did not have advance care plans were 2.5 times more likely to die from their illnesses than those who planned ahead.

Loberiza said he doesn't believe the plans had a direct effect on patients' success rates. Rather, he said, the type of person who's developed a plan often has attributes that contribute to better health, such as a healthy lifestyle and taking an active part in his or her care.

"We still don't believe that if you sign one, you'll survive," he said.

A federal law requires most hospitals to provide information about advance directives to patients at check-in, but it's estimated that fewer than one in 10 Americans have a plan.

Dr. James A. Tulsky, an administrator with the Duke University Health System in North Carolina who studies end-of-life care, said it's often difficult for patients and their families to come to terms with a difficult diagnoses and talk about health directives.

"It's important for physicians to bring this up," he said, but added the effectiveness of advance planning in prolonging life remains unknown.

Tulsky said the planning is useful for everyone, but it's particularly important for patients with terminal illnesses and the elderly. Patients who do not have advance health directives and later become incapable of making decisions about their health care are leaving the choices to their family members.

"They will do what they think is best, but it may not be exactly a reflection of your values at all," he said.

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