Cancer doctors dodge the death talk

[Excerpts from CNN]

Eileen Mulligan's doctor told her upfront that there are no good treatment options left to try for her cancer. He began gently. The chemotherapy is not helping. The cancer is advanced. There are no good options left to try. It would be good to look into hospice care. "At first I was really shocked. But after, I thought it was a really good way of handling a situation like that," said Mulligan, who now is making a "bucket list" -- things to do before she dies. Top priority: getting her busy sons to come for a weekend at her Washington, D.C., home.

Many people do not get such straight talk from doctors, who often think they are doing patients a favor by keeping hope alive. New research shows they are wrong.

Surprisingly, patients who had these talks were no more likely to become depressed than those who did not, the study found. They were less likely to spend their final days in hospitals, tethered to machines. They avoided costly, futile care. And their loved ones were more at peace after they died.

"Boiled down, it's 'Talking about dying will kill you,' " she said. In reality, "people crave these conversations, because without a full and candid discussion of what they're up against and what their options are, they feel abandoned and forlorn, as though they have to face this alone. No one is willing to talk about it."

...those who had end-of-life talks were three times less likely to spend their final week in intensive care, four times less likely to be on breathing machines, and six times less likely to be resuscitated.

Feeling nervous or worried was no more common among those who had end-of-life talks than those who did not.

From an ethics point of view, "it's easy -- patients ought to know," said Dr. Anthony Lee Back of the Fred Hutchinson Cancer Center in Seattle.

People react differently, though, said Dr. James Vredenburgh, a brain tumor specialist at Duke University. "There are patients who want to talk about death and dying when I first meet them, before I ever treat them. There's other people who never will talk about it," he said. "Most patients know in their heart" that the situation is grim, "but people have an amazing capacity to deny or just keep fighting. For a majority of patients it's a relief to know and to just be able to talk about it," he said.

James Rogers, 67 of Durham, North Carolina, wants no such regrets. Diagnosed with advanced lung cancer last October, he had only one question for the doctor who recommended treatment. "I said 'Can you get rid of it?' She said 'no,' " and he decided to simply enjoy his final days with the help of the hospice staff at Duke. "I like being told what my health condition is. I don't like beating around the bush," he said. "We all have to die. I've had a very good life. Death is not something that was fearful to me."