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Last Updated: Oct 28th, 2008 - 17:57:18 |
WASHINGTON (Reuters) - Talking about death may be upsetting but a doctor's frank discussion with a terminally ill person does no harm and provides numerous benefits for patients and those close to them, U.S. researchers said on Tuesday.
Patients who had talks about what type of care they want -- and do not want -- as they near death experienced a better quality of life in their waning days than those who did not, and they were no more apt to experience depression, worry or sadness, the study found.
The patients received fewer aggressive medical interventions, such as being placed on a ventilator to breathe, being resuscitated or being sent to an intensive care unit, the researchers reported in the Journal of the American Medical Association.
And the patients sought hospice care earlier.
In addition, their informal caregiver, usually a spouse or adult child, was less likely to experience major depression in the months after the patient's death if aggressive medical interventions were avoided.
"The major findings are that end-of-life discussions have cascading benefits for patients and their loved ones," Dr. Alexi Wright of the Dana-Farber Cancer Institute in Boston, one of the researchers, said in a telephone interview.
Wright's team said previous studies indicated that doctors and patients are ambivalent about talking about death and frequently avoid the discussions.
A doctor or a patient can initiate a discussion, which gives people the chance to define their goals and expectations for medical care as they approach death, Wright said.
"Talking about death is difficult. And the reason we started the study was we wanted to see if the conversations were worth it," Wright said. "We expected to find more evidence of psychological harm associated with the conversations but didn't find any."
The study involved 332 terminally ill cancer patients in Connecticut, Massachusetts, New Hampshire and Texas, of whom 123 reported having had such a conversation with their doctor.
These patients were more likely to accept that their cancer would kill them and expressed desire for comfort care near death over life-extending therapies, the researchers found.
On average, the patients were followed for the final 4-1/2 months of life. The researchers then assessed the emotional health of the caregiver an average of 6-1/2 months later.
Wright said the way a patient died influenced the way their loved ones lived on. People whose loved ones died in an intensive care unit were three times more likely to have major depression than those whose loved ones did not die in an ICU.
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