Guidelines from leading organizations recommend advance care planning for terminally ill patients with a life expectancy of 1 year; this includes a discussion of prognosis, “Do Not Resuscitate” status, hospice care and its setting. Yet according to the results of a study of over 4100 physicians, published in the online journal Cancer, the majority of doctors are reluctant to discuss palliative care and end-of-life issues with terminal patients and delay initiating these conversations rather than addressing difficult issues when patients are still well enough to make more informed decisions. The reluctance may in part be due to difficulty talking about death, a subject that younger doctors may have more ease with—younger physicians and physicians who were not cancer specialists reported discussing end-of-life options sooner than older physicians and cancer specialists, as did physicians caring for patients in HMO or Veterans Health Administration settings, the study found. Complicating the situation, little is known about patients' preferences regarding the right timing of such conversations. Some reports suggest that patients prefer early discussions, though this isn’t universal; some older individuals of certain ethnic groups do not believe patients should be informed that they have incurable cancer, the report mentioned. The authors conclude that more research is needed to understand all aspects of the situation: physicians' reasons for the timing of their discussions, what role of physicians' propensity to aggressively treat metastatic cancer has on the timing of discussions, patients' preferences for timing and how timing influences patients' and families' experiences at the end of life. Education as well as patient, physician and institutional interventions may be necessary to increase advance care planning for terminally ill cancer patients.
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