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."

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