New research shows doctors who want care to prevent pain and suffering at the end of their own lives are more likely to talk about that kind of care with patients facing the same dilemma, according to a study published in the Journal of the American Medical Association.
End-of-life care guidelines recommend that doctors discuss hospice care with patients who are expected to live less than a year, but physicians often delay those conversations, researchers discovered.
The research team, led by Garrett Chinn, M.D., of the Massachusetts General Hospital division of general medicine in Boston, asked 4,368 doctors their personal end-of-life care preferences, and if they would discuss hospice with a patient expected to live for another six months who currently didn't show any symptoms of illness, according to the study.
Roughly 65 percent of doctors strongly agreed they would receive hospice if they were terminally ill, while 21 percent somewhat agreed. Only about 27 percent of doctors said they would discuss hospice with a hypothetically dying patient "now," according to the study. The other physicians said they'd wait to discuss hospice until there were no more treatments to offer, the patient showed symptoms or if the family brought it up, according to the study.
That hesitation could be due to a number of factors including lack of physician training and preparedness, the patient or their family's denial or wish to avoid painful news and attempts to maintain hope for a different outcome, according to an opinion piece published in JAMA.
"When caring for patients with a terminal illness, physicians are challenged with difficult discussions and decisions, and many times these ignore the 'elephant in the room'--the fact that the patient is dying," authors Tanya H. Tajouri, M.D., and Timothy J. Moynihan, M.D., from the Mayo Clinic College of Medicine, Rochester, Minn., wrote.
The National Consensus Project for Palliative Care created new guidelines that promote continuity of palliative care across all settings, emphasizing collaboration within and among hospitals, community centers, hospices and home health agencies, FierceHealthcare previously reported. There's also a strong emphasis on psychological and psychiatric aspects of palliative care to enhance the collaborative assessment of psychological concerns and psychiatric diagnoses, including developing and offering a bereavement care plan prior to and for at least 13 months after a patient's death.