Doctors may also have reservations about their estimates of patients' remaining life span, the researchers wrote, making them reluctant to suggest immediately that patients think about hospice care or where they would like to spend their final days.
But such reluctance can have adverse consequences for patients and their families, Keating and colleagues argued.
"Waiting until all possible treatments are exhausted may delay discussions until it is too late for patients' preferences and values to be addressed," they wrote.
The study was part of a large, multistate project called the Cancer Care Outcomes Research and Surveillance Consortium, which involves more than 10,000 patients diagnosed from 2003 to 2005 with lung or colorectal cancer.
The New York Times’ Second Opinion column:
The results came as a surprise: the doctors were even more reluctant to ask certain questions than the researchers had expected. Although 65 percent said they would talk about the prognosis “now,” far fewer would discuss the other issues at the same time: resuscitation, 44 percent; hospice, 26 percent; site of death, 21 percent. Instead, most of the doctors said they would rather wait until the patients felt worse or there were no more cancer treatments to offer.
They were not asked for their reasoning, but Dr. Keating offered several possibilities. One is that doctors may disagree with the guidelines, which are based on expert opinion rather than data.
“Or they may not be comfortable discussing it,” she said. “These conversations are time-consuming and difficult. Some doctors may feel patients will lose hope. It’s easier to say, ‘Let’s try another round of chemotherapy,’ instead of having a heart-to-heart discussion.” Training may also be a factor, Dr. Keating said. Medical schools spend more time on end-of-life issues than they did in the past, and the greater willingness of younger doctors to broach the subject may reflect that change.
