Terminally ill patients and their physicians delay conversations about end-of-life choices, study finds

About half of terminally ill patients do not have discussions with their physicians regarding end-of-life choices, according to a Harvard Medical School study published in the Archives of Internal Medicine, the Boston Globe reports.

The study, funded by the National Cancer Institute, examined files on 1,517 patients in California, Iowa and Alabama with metastasized lung cancer. According to the Globe, a majority of patients diagnosed with metastasized lung cancer do not survive two years. Researchers asked the patients whether a physician or other health care provider had recommended hospice care or discussed end-of-life care preferences with them. According to the study, about 49% of blacks and 43% of Hispanics had discussed end-of-life care preferences with a physician or health care provider within four to seven months of their diagnosis, compared with 53% of whites and 57% of Asians.

Lead study author Haiden Huskamp, an associate professor at Harvard Medical School, said, "Patients who had unrealistic expectations about how long they had to live were much less likely to talk about hospice with their doctor." Huskamp theorized that patients who said they did not discuss end-of-life options with providers might not have completely understood their prognosis or chose to believe in a better outcome. Huskamp also said physicians typically are not well-trained to handle some delicate conversations (Lazar, Boston Globe, 5/26).

An abstract of the study is available online.