Doctors urged to be frank about advanced cancer patients’ odds, to help plan end-of-life care – chicagotribune.com

Doctors urged to be frank about advanced cancer patients’ odds, to help plan end-of-life care – chicagotribune.com.

The gist of this article is that oncologists are being encouraged to have conversations with patients about their treatments options, including the foregoing of aggressive treatments and just the provision of comfort, palliative measures.  A few quotes:

Patients don’t want to hear that they’re dying and doctors don’t want to tell them. But new guidance for the nation’s cancer specialists says they should be upfront and do it far sooner.

The American Society of Clinical Oncology says too often, patients aren’t told about options like comfort care or even that their chemo has become futile until the bitter end…

“This is a clarion call for oncologists . to take the lead in curtailing the use of ineffective therapy and ensuring a focus on palliative care and relief of symptoms throughout the course of illness,” the guidance stresses.

But it’s part of a slowly growing movement to deal with a subject so taboo that Congress’ attempt to give such planning a nudge in 2009 degenerated into charges of “death panels.”…

“There is going to be, over the next few years, a groundswell of people telling physicians, ‘I don’t want to go out in excruciating pain, short of breath, alone, surrounded by lights and sirens and people pounding on my chest,'” predicts Dr. Jonathan Weinkle, a primary care physician who advises the program.

“Everybody wants a good death but not a moment too soon, but they don’t have the language to ask for it…”

There is a general fear of planning for our end-of-life needs.  We often struggle with the recognition of the existence of death, and even for those who have accepted that death is inevitable, when facing one’s mortality, there is often an increased desire to avoid the topic.  People believe that if talking about death is avoided, then death won’t happen. 

As a Hospice chaplain, I often meet people who, even once they have decided on palliative Hospice care, still will not discuss their wishes out fear of depressing themselves or their loved ones.  While this is to be respected, I get the sense that a frank conversation would be of emotional benefit, and that the long term benefit would outweigh the short term verbalization of the person accepting his/her mortality.  Additionally, by the conversation being held with one’s physician, it could create a different dynamic that would be beneficial for the dying person.  Studies have suggested that people still have greater trust in their physicians, more so than for friends and family who offer advice.

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