Caregivers often struggle with how much to talk with their loved ones about the end of life. In a way, it seems easier to do so when it is abstract, long before it seems like an impending reality. As it turns out, doctors struggle with this too, but recent evidence suggests that quality of life for patients AND their caregivers is better when doctors level with their terminal patients.
In her May 28, 2009 New York Times article, "Doctor and Patient: Talking Frankly at the End of Life"
, Dr. Pauline Chen speaks both as a physician and as a family member about the importance of having those "difficult discussions" at and about the end of life. She speaks of the conversations that doctors and nurses had with her dying mother-in-law, and also about the important opporunities her husband and the rest of the family had to share with their Mom/Grandmother/Great grandmother.
Dr. Chen quotes a close friend of hers who said, "One of the scariest things in the world is to look someone in the eye and tell them they are dying." But Dr. Chen goes on to say that in her practice she does try to tell patients they are dying because she believes that it is worse when clinicians don't. Yet, she also points out that every doctor comes to these conversations with some anxiety, "... because it is hard not to feel as if you have failed your patients and their families, to wonder if taking out an inch more of bowel when removing the colon cancer, starting with a different antibiotic, or ordering a different diagnostic test might have somehow changed the course of events." She goes on to talk about the conversation itself. As Dr. Chen puts it, death and dying are"... words that can echo in a room long after they are said. Hopes can be shattered in an instant. Patients and families may feel abandoned. It is hard as a doctor not to wonder: Am I doing more harm than good?"
Dr. Chen cites a study, published in the Journal of the American Medical Association, that examined how end-of-life care discussions with terminal patients affected their quality of life and that of their caregivers. The study found that patients who had discussed end-of-life issues with their doctors were more likely to have better quality of life at the end of their lives with less aggressive care. The study also found that their caregivers fared better than caregivers whose loved ones had received more aggressive care.
So it seems that for many people, open and honest conversations about death and dying is desirable. What do you think? Do you think it is best when doctors are direct and honest with their terminal patients, or does this take something away from them? Read the article and share your thoughts.