Terminally ill patients and their family caregivers often feel
abandoned by their doctors and feel a sense of "unfinished business
with them, according to a new study by an oncologist at the Seattle
Cancer Care Alliance.
The study results, published today in the Archives of Internal
Medicine, identified two themes: before death, abandonment worries
related to loss of continuity of communication between patient and
physician; and at the time death or after, the patient's family's
feelings of abandonment from a lack of closure with the physician.
"Doctors often don't realize how important this issue is for
patients and their families," said lead author Anthony Back, M.D., an
expert on patient/physician communication. "Something as simple as a
phone call can go a long way toward allaying abandonment concerns," he
said.
The study found that physicians also reported a lack of closure when
patients died, but they did not associate this with abandonment.
"At first glance, continuity and closure may seem mutually exclusive
but these elements reflect different needs occurring at different times
in the dying process, the authors write. "Early on, patients and family
caregivers fear that their physicians, whose expertise and caring they
have come to depend on, will become unavailable.
Near death or afterward, the patient's family may experience a lack
of closure of their physician relationship. Physicians also report
similar feelings. "Most physicians are not consciously aware of having
abandoned their patients. Instead, they report a lack of closure or a
feeling of unfinished business, Back said.
The paper, "Abandonment at the End of Life from Patient, Caregiver,
Nurse and Physician Perspectives, contains many direct quotes from
patient and physician participants who were asked to answer a series of
questions about their perceptions and needs about continuity and
closure.
For example, this is what one patient told the researchers about the
impending loss of the relationship with the doctor: "I think that it's
important that you still have that contact with them even though there
isn't anything they can do to make you better.
Back and colleagues at the University of Washington School of
Medicine lay out a simple plan for how physicians and nurses can
achieve continuity and closure before and after a patient dies.