Friday, March 2, 2012

Terminally-ill Cancer Patients Discuss End-of-Life Plans with Physicians, Often Late

Researchers at the Dana-Farber Cancer Institute reported in a recent issue of the Annals of Internal Medicine that while the majority of patients with incurable lung or colorectal cancer discuss end-of-life care options with their physicians, those talks do not take place until much later in the course of the disease. Often the talk occur with a hospital physician, rather than the oncologist who has been treating the patient for their cancer.

"Previous studies have shown that patients who discuss their end-of-life care preferences with a physician are more likely to choose palliative, comfort-focused care over aggressive measures, and receive hospice or other care consistent with their wishes," says the study's lead author, Jennifer Mack, MD, MPH, of Dana-Farber/Children's Hospital Cancer Center. "But studies haven't looked at the timing of these discussions, or where and with whom they occur."

The new study, which involved 2,155 patients with stage IV (highly advanced) lung or colorectal cancer, found that 73 percent of the patients had an end-of-life care talk with a physician, according to medical records or an interview with the patient or a companion. Among the nearly 1,000 patients who passed away and whose records document an end-of-life care discussion with a physician, the median time of those discussions was just 33 days before death.

Other findings pertain to the location of those discussions and the type of physician involved. Of the more than 1,000 end-of-life care discussions in medical records, 55 percent occurred in the hospital. Oncologists documented end-of-life care talks with only 27 percent of their terminally ill patients in the study.