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Terminally ill cancer patients discuss end-of-life care with physician but often late
Date:2/9/2012

BOSTON--The vast majority of patients with incurable lung or colorectal cancer talk with a physician about their options for care at the end of life, but often not until late in the course of their illness, according to a new study by Dana-Farber Cancer Institute investigators published in the Feb. 7 issue of the Annals of Internal Medicine.

The researchers found that such belated conversations tend to occur under particularly stressful conditions when patients have been admitted to a hospital for acute care. And the doctor who shares in the end-of-life care talk is often a hospital physician, rather than an oncologist who has treated the patient for much of his or her illness.

Together, these circumstances may deprive patients of the opportunity for extended reflection and deliberation that would have been possible months earlier, when the conversation also could have occurred under less trying and hectic conditions, the authors suggest.

"Previous studies have shown that patients who discuss their end-of-life care preferences with a physician are more likely to choose palliative, comfort-focused care over aggressive measures, and receive hospice or other care consistent with their wishes," says the study's lead author, Jennifer Mack, MD, MPH, of Dana-Farber/Children's Hospital Cancer Center. "But studies haven't looked at the timing of these discussions, or where and with whom they occur."

The new study, which involved 2,155 patients with stage IV (highly advanced) lung or colorectal cancer, found that 73 percent of the patients had an end-of-life care talk with a physician, according to medical records or an interview with the patient or a companion. Among the nearly 1,000 patients who passed away and whose records document an end-of-life care discussion with a physician, the median time of those discussions was just 33 days before death.

Other findings pertain to the location of those discussions and t
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Contact: Bill Schaller
william_schaller@dfci.harvard.edu
617-632-5357
Dana-Farber Cancer Institute
Source:Eurekalert  

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