In an editorial appearing in the October 25 issue of The New England Journal of Medicine, medical oncologists at Johns Hopkins and Brigham and Women's hospitals provide a four-point plan for integrating palliative care discussions throughout the treatment of patients with terminal illnesses. They write that better planning and communication may improve symptoms, stress, and survival time, as well as lower health care costs at the end of life.
The two physicians suggest that their colleagues should discuss palliative care with patients during initial talks about prognosis at the first physician visit. This should be followed by further discussion about advance directives and hospice information (within the first three visits), and additional discussions of prognosis and coping (during periods when treatments change).
"Physicians are not as forthright as we should be with patients about their prognosis," says Thomas J. Smith, M.D., The Harry J. Duffey Family Professor of Palliative Medicine, professor of oncology, and director of Palliative Medicine at Johns Hopkins. "We do a fair job of communicating to patients that their terminal illness is incurable, but only one-third of doctors tell patients their prognosis at any time during their care."
A reason for this, Smith says, could be that doctors are afraid such discussions could take away a patient's hope. "What they don't realize is that hope is impossible to extinguish, and palliative care discussions can help patients focus on a better quality of life," regardless of prognosis, he adds. Palliative care is defined as treatment designed to set medically appropriate goals, comfort, manage symptoms, and ease pain, rather than cure the disease.