Greater Comfort, Peace of Mind at End for Those Who Talk About It

Talking about death can be difficult so it’s understandable that many people, including patients, loved ones and even doctors, shy away from doing so. Yet research demonstrates that end-of-life discussions can improve quality of life in the last weeks for the patient and ease the loss somewhat for family and loved ones. In particular, patients who are able to clarify their wishes concerning final medical care are more likely to have a peaceful and dignified death, confirms researcher Alexi A. Wright, MD, a hematology-oncology fellow at the Dana-Farber Cancer Institute in Boston.


A multi-site study measured the impact of end-of-life discussions on 332 terminal cancer patients and their families and friends, including 123 (37%) patients who reported having such conversations with their doctors. Among the benefits researchers identified…

  • End-of-life discussions were not associated with higher rates of worry or depression in patients. This is an important finding, since a reluctance to upset patients is frequently cited by doctors and family members as a reason not to initiate such conversations.
  • Patients who had end-of-life discussions were more apt to accept their disease as terminal, and to choose pain-relieving rather than aggressive, life-extending therapies that often don’t deliver on that promise. These patients were four times less likely to be put on ventilators or breathing machines… six times less likely to experience resuscitation… and three times less likely to be placed in intensive care units (ICUs) in their final week of life. All of these measures are common, costly and rarely extend life beyond a short period — also, aggressive care of this type is typically associated with more pain and discomfort and a worse quality of life.
  • Patients who had end-of-life discussions often began hospice care earlier, which is associated with a better quality of life. At present, Dr. Wright observes, a third of patients who go into hospice treatment do so only in their final days of life. This is unfortunate, since it takes time to make the transition. Importantly, patients who received hospice care for less than a week had the same quality of life as patients who had none at all, suggesting that early entry helps reap the benefits of hospice.
  • There was less bereavement-related depression among family members. Roughly six months after patients died, bereaved family members whose loved ones received aggressive end-of-life care were three times more likely to suffer regret and bereavement-related depression. They were also more likely to report they felt unprepared for their loved one’s death.

These results were reported in the October 8, 2008, issue of JAMA, The Journal of the American Medical Association.


According to Dr. Wright, the ideal time to think and talk about the medical care you’d like at the end of your life is well before it is in sight. It’s best to create advance directives, including a DNR (Do Not Resuscitate) order and Medical Power of Attorney, so they are in place ahead of time. “Patients’ health can deteriorate precipitously, leaving the family responsible for difficult decisions that may result in treatment patients didn’t want,” says Dr. Wright. Don’t put off talking about this because you aren’t sure now how you will feel in the future… you can always change your mind, though evidence suggests you probably won’t. New research from the University of Pennsylvania found great consistency in how people anticipated they’d feel about end-of-life care several years in advance and how they actually did feel. Among those who did experience a shift, most changed in the direction of wanting less aggressive care at the end than they’d predicted. Questions to consider include what sort of medical care (pain relief or aggressive treatment) you want at the end of your life, and whether or not you want to undergo heroic measures such as resuscitation and ventilation. If you do, under what circumstances?

End-of-life discussions offer an opportunity to increase patients’ control over their own deaths and to reduce their suffering. They bring peace of mind to both patients and their families. In acknowledging that death is near, patients, family members and physicians can focus on comfort, rather than resorting to painful and often fruitless interventions.

To learn more about end-of-life medical care and discussions and options such as advance directives, visit Web sites such as the following…

  • Caring Connections, The National Hospice and Palliative Care Organization, at