A new study has shown that straight talking elderly people, who are facing death in nursing homes, raises the likelihood of them agreeing to enter hospices in the last days of their life.
Hospices are facilities which specialise in end-of-life care and are able to offer more appropriate care than nursing homes.
Study leader Dr. David Casarett, director of the palliative care clinic at the Philadelphia Veterans Affairs Medical Center, says that over the last 10, 20, 30 years all sorts of high-tech and expensive interventions to improve end-of-life care have been tried, but by just getting people to talk, more are prepared to enter into the hospice sooner.
He says people who have these conversations are more satisfied with the end-of-life care they receive.
At the outset of the study Casarett and his colleagues interviewed nursing home residents or the people who made medical decisions for them, in an attempt to identify those who would benefit from entering hospices.
Out of the 205 nursing home residents who were selected, 107 were given an informational visit describing hospice care, and 98 received the usual care.
The researchers found that one of every five people who got the informational visit entered a hospice within the next 30 days, compared to only one person among those who received usual care.
Eventually, 25 percent of those getting hospice information entered hospices, compared to 6 percent of those who did not.
The researchers noted that the people who entered hospices had fewer acute care hospital admissions and spent fewer days in hospital.
Probably the most important finding was that, family members of those who entered hospices rated the quality of end-of-life care higher, 4.1 on a scale of five, compared to 2.5 for those remaining in nursing homes.
Casarett says that many people nearing the end of life, may not want to have these discussions for a variety of reasons, but on the other hand, many people do, but don't know how.
He says that previous studies have shown that many people are thinking about hospices but are waiting for their physicians to start these discussions.
Although doctors and nurses often have such conversations with patients, it is not done in a systematic way.
He hopes hope that the study will help change that issue.
Background information for the article states that at least one in four Americans dies in a nursing home, and considerable evidence indicates that nursing home residents do not receive optimal end-of-life care.