Terminal Diagnosis May Improve End-of-life Care

NEW YORK (Reuters Health) - Dying cancer patients may get better end-of-life care if their doctors give them a formal diagnosis of terminal illness, according to a new study.

In Denmark, where the study was performed, patients who a doctor considers to have less than six months to live may be given a "terminal declaration," which authorizes increased reimbursement for medicines as well as the right to paid full- or part-time leave for caregivers.

But most doctors will not define a patient as having terminal illness, or may give overly optimistic estimates of their prognosis, Dr. Birgit Aabom of the Institute of Public Health at the University of Southern Denmark in Odense and colleagues point out in the Journal of Clinical Oncology. This can mean patients may require emergency hospitalization due to poor coordination of at-home care, and can have other negative effects on palliative care, that is care intended to make a patient more comfortable rather than to cure the disease.

Aabom and her team set out to determine how frequently terminally ill patients received a terminal declaration, and whether some patients were less likely than others to be given the diagnosis. They reviewed records for 3,445 patients who had died of cancer.

One-third had received a terminal declaration, the researchers found. Patients who received the diagnosis were less likely to be admitted to the hospital, and substantially less likely to die in the hospital rather than at home.

"The key finding in our study is that making the transition from curative to palliative phase explicit provides the primary health care sector, i.e. community nurse, GP and other caretakers with a possibility to plan the last weeks of life," Aabom told Reuters Health in an e-mail interview. "Furthermore, a terminal declaration might open up the communication around the patient and provide better soil for end-of-life discussions, i.e. desires to place of death."

In the United States, in order to receive Medicare coverage for hospice care, patients and their families must forego acute or curative care, Dr. Eduardo Bruera of the University of Texas M.D. Anderson Cancer Canter in Houston points out in an accompanying editorial. Making this decision, he adds, means opting out of effective treatments for relieving pain, as well as participation in clinical trials.

While the findings suggest that the terminal diagnosis can improve end-of-life care planning, he adds, this "can only be considered one of a number of interventions needed to improve care for terminally ill patients and their families."

SOURCE: Journal of Clinical Oncology, October 20, 2005.