End-of-life talk has cascading benefits: study

By Megan Rauscher

NEW YORK (Reuters Health) - In terminally ill patients, "end-of-life" discussions with their doctor do not increase emotional distress or reduce quality of life, a study shows. On the contrary, these discussions improve the quality of life of both the patient and loved ones when death is near.

"We did this study," Dr. Alexi A. Wright told Reuters Health, "because talking about death is difficult and upsetting and we wanted to know whether these conversations are worth it; do they improve patients' quality of life and medical care at the end of life?"

"What we found was that these conversations have cascading benefits for patients and their loved ones," she said.

Wright, from the Dana-Farber Cancer Institute, Boston and colleagues examined the associations between end-of-life conversations, medical care near death, and patient and family mental health for 332 patients with advanced terminal cancer and their spouse or adult child.

"Patients who remembered having these conversations were three times less likely to be admitted to the intensive care unit, four times less likely to be put on a breathing machine, and six times less likely to undergo resuscitation in their last week of life," Wright told Reuters Health.

Patients who had end-of-life conversations also entered hospice earlier and longer hospice stays were associated with better quality of life, while more aggressive end-of-life intervention was associated with worse patient quality of life.

"And surprising to me," Wright said, the loved ones of the terminal cancer patients who received intensive end-of-life interventions had a threefold higher risk of developing major depression 6 months after the patient died.

"This study really brings home the message that patients' experiences near death have lasting effects on how their loved ones live after they are gone," Wright said.

In the study, which appears in this week's issue of the Journal of the American Medical Association, more than 60 percent of dying patients did not recall having end-of-life discussions with their doctors.

"It's really important," Wright said, "for cancer patients with advanced disease to talk to their doctor about the kind of medical care they want to receive at the end of their lives because their mental and physical condition often deteriorates rapidly and if their families and physicians do not understand their wishes before this happens they may get medical care they never wanted."

SOURCE: Journal of the American Medical Association, October 8, 2008.