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

t that's purely designed to ease suffering.

Does this mean that terminal patients who discuss their wishes earlier are more likely to get the treatment they desire at the ends of their lives?

"That would be an inference. Patients who understand a poor prognosis are more likely to choose less aggressive care at the end of life," Mack said. "Not every patient wants palliative and less aggressive care, but most who recognize that they're dying want that."

Dr. Kathleen Unroe, an assistant professor of medicine at the Indiana University Center for Aging Research, said that "earlier discussions give patients and their families time to think through what their preferences and goals of care are, and gives them more time to communicate these wishes to providers."

It's disturbing, however, that the study revealed that some patients -- especially blacks and Hispanics -- didn't realize they'd had discussions about end-of-life care, she said.

Dr. David Casarett, director of research and evaluation at the University of Pennsylvania Hospice and Palliative Care, praised the study, saying it "provides welcome evidence that end-of-life discussions may be able to change the trajectory of serious illness in positive ways."

"Having earlier discussions -- ideally throughout the course of an illness -- gives patients a chance to ask questions, understand likely future events and clarify their goals," Casarett said. "Many of those discussions will bring to light new information or preferences, making it clear that a patient wants treatment that is less aggressive that what is being planned. When that happens, there is a unique opportunity to reconsider goals, opening the door to a plan of less aggressive treatment."

The study appears in the Nov. 13 online issue of the Journal of Clinical Oncology.

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