The Unintended Consequences Of Avoiding End Of Life Planning

2011-09-29 | |
Last updated: 2011-09-29

Patients Need To Be More Involved In Planning For Death

To make plans, however, patients must be involved and informed enough to decide whether living longer or living better is preferable. More often than not, it is not possible to achieve both. Having these conversations requires a willingness on the part of terminally patients to be actively involved in their treatment. A 2005 study by Texas A&M University discovered that active patient involvement in treatment discussions involved the patient initiating communications in 84% of cases. In other words, unless the patient indicates their interest in being involved, the doctor will most often take the lead.

Doctors Must Make An Effort To Talk About Dying

Although we could blame patients for not being proactive in talking about impending death, a considerable part of the blame also falls at the feet of doctors. In one study conducted by the VA Puget Sound Health Care System published this year, researchers found that physicians interacting with terminally ill patients did not discuss future treatment decisions, life expectancy, spiritual beliefs or what dying would be like in 85% of cases. The consequence of this is that terminally ill patients are often not even guided in dealing with many aspects of what will later come.

Further to this research, a study from Brigham and Women’s Hospital found that roughly 2 in 3 doctors treating terminally ill patients only focused on the present. They would not actively try to discuss a patient’s future if the patient felt good. They would only begin talking to patients on the subject once further symptoms appeared or all treatment options were exhausted. The same study found that only 1 in 5 doctors discussed with patients where they would choose to spend their final days.

Because of this lack of communication and focus on end of life planning, many terminally ill patients often end their final days in ways that they would not prefer. This includes receiving futile treatments and ultimately dying in the hospital. A study from the Italian National Cancer Institute found that 94% of patients would prefer to die at home while this happened for only 58% of the terminally ill patients in the study.

A similar study by the US National Cancer Institute found that in the Canadian province of Ontario where public healthcare is available, 49% of patients with a form of lung cancer ultimately died in hospital. This is despite the majority of people in the region preferring to die at home. Quite clearly, patients and health care providers are not talking enough to make appropriate plans for patients that would respect patient desires.

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Category: General Health, Healthcare Politics, Medical Treatment

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