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Doctors vary on willingness to talk about hospice

NEW YORK (Reuters Health) – Doctors’ personal preferences may influence when they discuss end-of-life care with patients, says a new study.

Doctors who said they would opt for palliative care at the end of their own lives were more likely to discuss that type of care with a hypothetical dying patient.

“Although most patients do ultimately talk about some end-of-life topics before they die, the vast majority of these conversations happen during acute care hospital stays and at the end of life,” said Dr. Nancy Keating of Harvard Medical School in Boston, the study’s senior author.

Many guidelines recommend doctors discuss hospice with patients who are expected to live for less than a year. But Keating and her colleagues write in a research letter published December 16 online in JAMA Internal Medicine that those conversations are often delayed.

For the new report, they used data from 4,368 U.S. doctors who took part in a study that looked at variations in cancer care across the U.S.

Researchers asked doctors about their preferences for their own end-of-life care. They also asked them when they would discuss hospice with a hypothetical patient with cancer who was expected to live for another four to six months and was currently asymptomatic.

About 65% of doctors strongly agreed they would enroll in hospice care if they were terminally ill. Another 21% somewhat agreed they would enroll.

Only about 27% of doctors said they would discuss hospice “now” with the hypothetical dying patient, however.

The others said they would wait to discuss hospice until the patient was hospitalized, the patient had symptoms, the patient’s family brought it up or until there were no more treatments to offer.

Overall, the researchers found about 30% of the doctors who strongly agreed that they would enroll in hospice toward the end of life would discuss palliative care with the hypothetical patient, compared to about 20% of doctors who provided other answers about their own end-of-life care.

“It still is much lower than I think it should be,” Keating told Reuters Health.

“There is a lot of concern among physicians that talking about end-of-life care with patients with advanced cancer, who have a short life expectancy, will have patients lose trust in them,” she said. But there is little data to support those concerns.

Previous studies have found patients are more likely to get care in line with their wishes when hospice is discussed early.

“I think – in general – we should all be doing this a lot more,” Keating said.

In an essay published in the same journal, Dr. Tanya Tajouri and Dr. Timothy Moynihan from the Mayo Clinic in Rochester, Minnesota, tell the story of a dying 55-year-old man who was brought to their hospital.

Instead of involving palliative care services after his diagnosis, the man was aggressively treated and had a heart defibrillator surgically implanted. He died less than a month after coming to the hospital.

“When caring for patients with a terminal illness, physicians are challenged with difficult discussions and decisions, and many times these ignore the ‘elephant in the room’ – the fact that the patient is dying,” Tajouri and Moynihan write.

“People are still reluctant to talk about death, but this is one of those things that will absolutely happen to everybody,” Keating said.

SOURCE: http://bit.ly/1fzKhik

JAMA Intern Med 2013.