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Archive for Monday, June 16, 2008

Most cancer doctors avoid talking about the end

Cancer patient Eileen Mulligan, 68, rests in the backyard of her Washington home Thursday. Only one-third of terminally ill cancer patients in a new, federally funded study said their doctors had discussed end-of-life care.

Cancer patient Eileen Mulligan, 68, rests in the backyard of her Washington home Thursday. Only one-third of terminally ill cancer patients in a new, federally funded study said their doctors had discussed end-of-life care.

June 16, 2008

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— One look at Eileen Mulligan lying soberly on the exam table and Dr. John Marshall knew the time for the Big Talk had arrived.

He began gently. The chemotherapy is not helping. The cancer is advanced. There are no good options left to try. It would be good to look into hospice care.

"At first I was really shocked. But after, I thought it was a really good way of handling a situation like that," said Mulligan, who now is making a "bucket list" - things to do before she dies. Top priority: getting her busy sons to come for a weekend at her Washington, D.C., home.

Many people do not get such straight talk from doctors, who often think they are doing patients a favor by keeping hope alive.

New research shows they are wrong.

Only one-third of terminally ill cancer patients in a new, federally funded study said their doctors had discussed end-of-life care.

Surprisingly, patients who had these talks were no more likely to become depressed than those who did not, the study found. They were less likely to spend their final days in hospitals, tethered to machines. They avoided costly, futile care. And their loved ones were more at peace after they died.

Convinced of such benefits and that patients have a right to know, the California Assembly just passed a bill to require that health care providers give complete answers to dying patients who ask about their options. The bill now goes to the state Senate.

Some doctors' groups are fighting the bill, saying it interferes with medical practice. But at an American Society of Clinical Oncology conference in Chicago earlier this month, where the federally funded study was presented, the society's president said she was upset at its finding that most doctors were not having honest talks.

"That is distressing if it's true. It says we have a lot of homework to do," said Dr. Nancy Davidson, a cancer specialist at Johns Hopkins University in Baltimore.

Doctors mistakenly fear that frank conversations will harm patients, said Barbara Coombs Lee, president of the advocacy group Compassionate Choices.

"Boiled down, it's 'Talking about dying will kill you,'" she said. In reality, "people crave these conversations, because without a full and candid discussion of what they're up against and what their options are, they feel abandoned and forlorn, as though they have to face this alone. No one is willing to talk about it."

The new study is the first to look at what happens to patients if they are or are not asked what kind of care they'd like to receive if they were dying, said lead researcher Dr. Alexi Wright of the Dana-Farber Cancer Institute in Boston.

It involved 603 people in Massachusetts, New Hampshire, Connecticut and Texas. All had failed chemotherapy for advanced cancer and had life expectancies of less than a year. They were interviewed at the start of the study and are being followed until their deaths. Records were used to document their care.

Comments

inklines 6 years, 6 months ago

Yellowhouse,Have you ever had to care for someone or loved someone who was terminally ill? Did you tell them to deal with it!?One of the hardest things I have ever had to do was walk from the doctor in the hallway into my young wife's hospital room, tell her that all the cancer treatments were not working and that she was going to die very soon. She fought the disease for three years with all her strength, will, and humor. Yes, patients need to know they are dying, but they also need to know hope, compassion and empathy. When doctors are silent on all of these, then medicine fails.

yellowhouse 6 years, 6 months ago

Here is what the doctor should say,lYou are terminal, you have been terminal your entire life. Now you are just a little closer to the terminality. Within the next six months, Find God..cause he is looking for you, Tell your kids you love em, make all the wrongs right, Go sky diving, be naughty and deal with it!

denak 6 years, 6 months ago

I wouldn't tell a patient to "just deal with it" but I do believe there is a time to be frank with the patient and it is a greater kindness to do so. Personally, I would want to know so that I could make plans. Go through the steps of grief. I don't know if I would want to believe right up to the end, that I was going to make it. I believe that a doctor should encourage his or her patient and give them hope, but I don't believe that a doctor should give someone false hope.Dena

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