Discussing the possibility of death with a medical professional can be difficult for terminally ill patients, often leaving them with an uneasy or upsetting feeling. However, recent studies are suggesting that it may provide many benefits for not only the patient, but the patient’s loved ones as well.

In a study conducted by the Dana Farber Cancer Institute, 332 terminally ill patients were studied. The patients were observed for an average of the last 4 ½ months of their life. Of the 332 patients, 123 patients had conversations with their doctor about their possible death.

These 123 patients who had an end-of-life conversation were more likely to accept care that primarily focused on their comfort, such as hospice care. In hospice care, the medical attention that patients receive is focused on their own comfort, often taking place in their own home or a similar, comfortable setting. Some suggest that hospice care offers a better quality of life, rather than taking measures to hasten or prolong death.  For instance, a patient being admitted into intensive care (ICU) may very well prolong their life, but it may come at the expense of the comfort level for not only the patient, but loved ones as well. Often times, more aggressive medical approaches, such as being placed on a ventilator to breathe, can not only be physically painful for the patient, but mentally and emotionally tasking on the patient and their family.

Along with the patients themselves, researchers assessed the mental health of family members of the deceased, typically about 6 ½ months after their loved one had passed away. Family members of those who did not die in the ICU were 3 times less likely to show signs of depression stemming from the death.

“The major findings are that end-of-life discussions have cascading benefits for patients and their loved ones.” Dr. Alexi Wright, of the Dana Farber Institute, said in a telephone interview.

If you would like to read more on the study click here.

For more information on hospice click here.

In June, I blogged about a California bill addressing end-of-life rights for patients. A similar bill is currently stuck in committee in Vermont and a proposition for a federal bill is being brought to the Senate's attention. It would be the first act of its kind to gain national passage.

The California bill requires doctors to teach terminal patients about end-of-life options such as hospice homes and palliative care, so that the patients know they are not obligated to continue aggressive treatment regiments. Under the bill, doctors must give this straight talk to patients who are expected to survive less than a year.

This bill puts the patient in power of decision-making. Without this provision, physicians control how much patients knows. This bill ensures that the patient is fully informed and can make educated and knowledgeable choices regarding their health, treatment, and end-of-life environment.

Physicians are obligated to present options to patients, but not endorse any. Nevertheless, the bill has garnered opposition from politicians who believe that it is setting the stage for assisted suicide cases. While palliative care aims only to comfort a patient in their last days, it has been known hasten the process of dying.

California's measure is known as the "Terminal Patients' Right to Know End-of-Life Options Act." Under the bill, physicians who do not comply with the terminal patient's wishes must refer the person to a new doctor who will carry out his or her intentions.

Many doctors fear that compliance with the bill will be hard to guarantee, as it is often difficult to predict a patient's likelihood of surviving a year. To this point, some oncologists believe that discussing end-of-life options too early can cause the patient harm. Though this point was essentially debunked in a recent study, physicians struggle to find a balance between informing their patients and overwhelming them. Some doctors warn against divulging details too soon: "What most people want to know about are hospice and palliative care. They may not be asking about last-resort options like palliative sedation and stopping eating and drinking," said Dr. Quill, director of the University of Rochester Medical Center's palliative care program in New York.

Thomas J. Smith, MD, an oncologist and co-author of a Journal of the American Medical Association article on poor communication between cancer patients and doctors, said the California law "is something that could be tested in one state, and if it works, then it could potentially be applied to other states. It certainly raises awareness of the issues."

For more information, visit this site.

Facing mesothelioma or losing a loved one to the disease can cause feelings of severe loss and grief. The ways which individuals cope with this sorrow differ greatly, even on a physiological level. A new study out of UCLA suggests that individuals with "complicated grief" experience increased brain activity in surprising areas.

"Complicated grief" refers to sorrow that does not diminish over time, as may be expected. In the UCLA study, 23 women who had lost a mother or sister to breast cancer were examined. Twelve of them had noncomplicated grief, while the other 11 suffered from complicated grief. The subjects without complicated grief demonstrated the expected brain activity on a functional MRI test when shown pictures of their lost relatives. In both subject groups, the brain regions associated with physical and emotional pain were active. In the women with complicated grief, however, brain activity also occurred in the nucleus accumbens-- an area of the brain associated with earning rewards.

Researchers were initially puzzled by this discovery; the brain activity seemed to indicate that the grief was pleasurable, thus stimulating the "reward" area of the mind. Upon further testing, the doctors concluded that the nucleus accumbens also reacts when individuals desire or crave something, such as a reward. In the subjects suffering from complicated grief, the nucleus accumbens became active because they physically yearned for their lost relative. In a survey, these women were more likely to say they longed for the deceased.

These new results will help counselors better assess their clients who suffer from complicated grief by attuning them to the physical yearning they experience. This is the first study to determine a neurological explanation for the persistent longing that occurs in about 10-20% of people who lose loved ones. For more information on the study, go here.

For many mesothelioma patients, end-of-life treatment is a primary concern.  While some opt to maintain aggressive therapy, others elect to enter hospice care.  In the UK, one man took matters into his own hands: he arranged a wake-like gathering for family and friends before his death.

Nigel Phillips worked on docks for over 20 years.  The 61-year-old was recently diagnosed with mesothelioma and given only 12 months to live.  Upon receiving the news, he organized a small get-together with some friends for drinks.  A fellow dock-worker, however, spread the news of Nigel's party and his diagnosis.  What started out as a handful of guests turned into a group of 100 colleagues, coworkers, and friends who came to pay Nigel respect.

The part was gratifying for Nigel, who is unsure how the disease will progress.  Though he has been treated in Cambridge at excellent facilities, he knows mesothelioma can be unpredictable.  In seeing all his friends, Nigel was equipped with the emotional support and security needed to handle the cancer.

To read more about Nigel's story, click here.

Doctors often mistakenly fear that frank conversations with their patients about death will harm them. Now, a new study confirms that these fears are unfounded; avoiding conversations about death provided no benefit while being direct with patients yielded a host of advantages.

Patients who received straight talk from doctors were no more likely to become depressed than patients whose doctors did not address death. They were less likely to spend their final days in hospitals, connected to machines, paying for futile care. Once they died, their families were more at peace. These findings come from a study of 603 patients whose cancer did not respond to chemotherapy. The Dana-Farber Cancer Institute in Boston is publishing the results.

Being well-informed about death and their diagnosis gives patients the opportunity to explore options such as hospice care. Having a conversation early on about dying affords them the time to seek out resources pertaining to death and loss.

Every patient responds differently to a terminal diagnosis, but from an ethical standpoint, patients have the right to know their likelihood of survival. Mental and emotional preparation for death can help ease the process for both the patient and their family. The California Assembly believes so strongly in frankness about death, that they recently passed a bill requiring health care providers to give complete answers to dying patients who inquire about their options.

Some doctors are protesting the bill, insisting it interferes with proper medical practice. Why do so many doctors dodge the death discussion? Some fear that it will smother the patient's hope. For others it generates a sense that they have failed the patient if they quit battling the disease. But for many individuals, candid and honest conversations about death are a way to build trust, remove anxiety, and eliminate feelings of isolation.

"I like being told what my health condition is. I don't like beating around the bush," said one 67-year-old cancer patient. "We all have to die. I've had a very good life. Death is not something that was fearful to me."

Click here to read more. For resources on facing death and coping with loss, click here.