Patients discuss end-of-life wishes, but not with docs

When it comes to end-of-life planning with older adults, a recent study published in JAMA Internal Medicine suggests there's good news and bad news about how patients' wishes are handled.

The encouraging finding is that about 75 percent of the 278 Canadian patients in the study--who were a mean 80 years old and "at high risk of dying in the next 6 months"--said they had thought about end-of-life care before being hospitalized, and the majority of them had discussed their goals for care with a family member.

"I was heartened by what a high percentage of people actually had discussed preferences," Dr. Mary Tinetti, chief of geriatrics at the Yale University School of Medicine in New Haven, Connecticut, who wasn't involved in the new study, told Reuters Health. "Patients really are beginning to feel comfortable having those conversations, at least with their family."

The downside, however, is that most of these patients, all suffering from advanced pulmonary, cardiac disease, liver disease or metastatic cancer, had not discussed their end-of-life wishes with their primary care physicians or hospital clinicians. Even when people's wishes were noted in their medical records, Medpage Today reported, two-thirds of the time those notes differed from what patients and their family members told interviewers.

According to lead author Dr. Daren Heyland, from Kingston General Hospital in Ontario, and colleagues, patients interviewed by the team typically preferred less aggressive treatment than what was recorded in their medical records.

"That to me is a huge and alarming problem, that an 80-year-old patient says, 'When it comes to the final stages of life, just focus on keeping me comfortable,' and on their medical record, they're up for full resuscitative practices," Heyland said.

To learn more:
- see the abstract from JAMA Internal Medicine
- read the article from Reuters Health
- see the story from MedPage Today

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