Alexi A. Wright, MD
Alexi A. Wright, MD, a hematology-oncology fellow and research scholar at the Center for Psycho-Oncology and Palliative Care Research, Dana-Farber Cancer Institute, Boston, Massachusetts.
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…
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…