And estimating how long someone has to live is an inexact science. A doctor may have a sense of how long someone has, but an individual patient may die much sooner or later than that, Lichtenfeld said.
"It's difficult to turn to another human being and say, 'I think you have six to 12 months to live,'" Lichtenfeld said. "Doctors are trained to save lives. They want to believe, and the patient wants to believe, they are going to be different from the average. Doctors don't want to take away that hope."
Not only are doctors treading a fine line between being unnecessarily bleak and giving patients the opportunity to make choices, patients can differ in how much they want to be told. "Some want to know more than others," Keating said. "The issue is everybody deserves to hear a little about what the options are and how aggressive they want treatments to be."
Families can be another complicating factor, Lichtenfeld said. Even when patients say they no longer want to continue treatment and instead want only palliative care, heartbroken family members can resist, urging the loved one to keep fighting.
As the nation grapples with reining in health care costs, the survey also raises the issue of doctors offering expensive chemotherapy for terminally ill patients even when there's little chance it will work, Keating said. Other research has shown that the use of chemotherapy is increasing at the end of life, even for cancers generally considered unresponsive to the drugs, according to background information in the article.
"It may be that doctors are just not comfortable talking about something that is challenging, difficult and time consuming," Keating said. "It may also be that doctors are not reimbursed for these discussions but the
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