By The Numbers; End-of-Life Discussions with Patients

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The potential federal healthcare overhaul engendered a bitter debate over rumored “death panels” making end-of-life decisions for patients. Although the claims were never substantiated, the furor directed the nation’s attention to the important issue of end-of-life care. Patient-physician communication about end-of-life care plays a vital role in treatment decisions; however, individuals and their physicians are often ambivalent about broaching such topics as advance directives (AD) and do not resuscitate (DNR) forms. We took a closer look at data concerning these difficult patient-physician conversations.

Living Will

75 patients with cancer responded to questions about end-of-life care^a:

hospice care

81% heard of the term

75% previously discussed ADs

41% had completed an AD

24% denied completing an AD or ever discussing ADs with another person

21% reported knowledge of palliative care

J Clin Oncol.

^a Dow LA, Matsuyama RK, Ramakrishnan V, et al. Paradoxes in advance care planning: the complex relationship of oncology patients, their physicians, and advance medical directives. 2010;28(2):299-304.

Physicians’ Willingness to Discuss Specific End-of- Life Issues “Now”^b

(“Now” defined as an asymptomatic patient with 4 to 6 months to live.)

Data based on survey of 4074 physicians. Younger physicians were more likely to report discussing prognosis, DNR status, hospice, and preferred site of death “now.” Female physicians were more likely than male physicians to report discussing prognosis “now,” and physicians with more terminally ill patients were more likely than others to report discussing prognosis and DNR “now.”

^b Keating NL, Landrum MB, Rogers SO Jr, et al. Physician factors associated with discussions about end-of-life care. Cancer. 2010; 116(4):998-1006