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Later End-of-Life Discussions May Mean More Aggressive Treatment
Date:11/13/2012

By Randy Dotinga
HealthDay Reporter

TUESDAY, Nov. 13 (HealthDay News) -- Terminally ill people who get early counseling about end-of-life care undergo less aggressive medical treatment in their final days, a new study reports.

The findings suggest -- but don't prove -- that patients who only discuss their wishes at the last minute end up undergoing more lifesaving efforts such as chemotherapy and intensive care. Those who discuss their wishes earlier are more likely to undergo the alternative -- treatments like hospice care whose main purpose is to reduce suffering, not to continue extending life as long as possible.

The findings show the importance of talking about a patient's wishes as soon as possible, said study author Dr. Jennifer Mack, an assistant professor of pediatrics at Harvard Medical School. "By having these discussions earlier, patients can understand what's ahead and make decisions about what's good for them."

The last several decades have spawned intensive debate about whether aggressive medical treatment at the end of life results in unnecessary suffering. In the new study, said to be the first of its kind, researchers sought to understand whether the timing of discussions with patients about terminal illness made any difference in their care as they died.

The researchers tracked 1,231 patients with terminal lung or colorectal cancer who died over a 15-month period.

Of those who only discussed end-of-life care in the final month of life, 65 percent received what the researchers considered to be aggressive care in those last 30 days.

By contrast, consider the patients who discussed end-of-life care more than three months before death: Only about a third of them received aggressive treatment in their final 30 days.

Overall, the numbers suggest that delaying discussions of end-of-life care leads to more aggressive treatment during a patient's final days instead of treatmen
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