Associations Between End-of-Life Discussions, Patient Mental Health, Medical Care Near Death, and Caregiver Bereavement Adjustment (JAMA)

The October 8 issue of the Journal of American Medical Association reports on a multi-site study of patients with advanced cancer and their informal caregivers from September 2002-February 2008.

The context for the study was that "Talking about death can be difficult. Without evidence that end-of-life discussions improve patient outcomes, physicians must balance their desire to honor patient autonomy against a concern of inflicting psychological harm."

The results of the study, based on the 37% of patients who had end of life discussions before baseline, was that such discussions were not associated with higher rates of major depression or more worry while such discussions were associated with lower rates of ventilation, resuscitation, ICU admission, and earlier hospice enrollment. More aggressive medical care was associated with worse patient quality of life and higher risk of major depression in bereaved caregivers whereas longer hospice stays were associated with better patient quality of life. Better patient quality of life was associated with better caregiver quality of life at follow-up.

The study concluded that "End-of-life discussions are associated with less aggressive medical care near death and earlier hospice referrals. Aggressive care is associated with worse patient quality of life and worse bereavement adjustment."

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