A new survey has found that most doctors do not feel comfortable talking about end of life issues with their cancer patients when those patients are feeling well. They do not talk about end of life issues until treatments have been exhausted. Those delays mean that patients may not be able to make truly informed choices early in their treatment.
The study, published online on January 11, 2010, in the journal, Cancer, surveyed 4,188 physicians about how they would talk to a hypothetical cancer patient with four to six months to live. A majority of the doctors (65%) said they would discuss prognosis, but only a minority said that they would discuss do not resuscitate status (44%), hospice (26%), or preferred site of death (21%) at that time. Rather, the doctors indicated that they would rather wait until symptoms were present or until there were no more treatments to offer.
Current guidelines, from the National Comprehensive Cancer Network, a non-profit alliance of 21 of the world’s leading cancer centers, says that such conversations should be initiated whenever a patient has been given less than a year to live, if not at diagnosis. The doctors responding to the survey gave a variety of reasons for not following the guidelines. Some do not want to dash a patient’s hopes, others wanted to continue treating patients. According to one author, Dr. Nancy Keating of Harvard Medical School, “there is at least some evidence that suggests that patients don’t want to hear about these things.” (Los Angeles Times, January 25, 2010).