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Even though talking about death with patients can be difficult and upsetting for patients and their families, a study suggests that it's well worth the effort. Researchers studied 332 patients with advanced terminal cancer and their spouses or adult children and examined associations between end-of-life conversations, medical care near death, and patient and family mental health. They found that patients who remembered having these conversations with their healthcare provider were three times less likely to be admitted to the ICU, six times less likely to undergo resuscitation attempts in their last week of life, and seven times less likely to be put on a mechanical ventilator.


Patients who had end-of-life conversations with care providers were also more likely to enter hospice earlier than other patients. Longer hospice stays were associated with better quality of life. In contrast, aggressive end-of-life interventions were associated with poorer quality of life for patients, and the loved ones of patients who'd undergone aggressive interventions were three times as likely to develop major depression 6 months after the patient's death.


More than 60% of dying patients couldn't recall having end-of-life discussions with their care providers. The researchers say care providers should initiate such conversations so patients get the kind of end-of-life care they want.


Source: Wright AA, Zhang B, Ray A, et al. Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. JAMA. 2008;300(14):1665-1673.