Blog | Wednesday, June 11, 2008

The hardest conversation


The perceptions of patients who are nearing the end of life seem to be a hot research topic right now, at least over at JAMA.

Last issue, a study ran which concluded that "ambulatory patients with heart failure tended to substantially overestimate their life expectancy compared with model-based predictions for survival." Initially, the research seemed to us to verge on the obvious. Why torment these people in their last days by eliciting their overestimates about survival? Isn't another way to describe those "overestimates" actually "hope"?

But a case study of end-of-life chemotherapy, in this week's JAMA, delves a little further into the issue. The authors claim (and they use both research and individual anecdotes to back this up) that physicians frequently fail to adequately explain the likelihood of survival to patients, and even if they do, patients often misunderstand. These misunderstandings (or overestimates), in turn, cause the patients to choose care that is not in their best interest (i.e., more chemo over hospice).

As for our concern about hope, the authors shoot that one down firmly but briefly. "No data are available that show hope can be taken from patients," they say. Good to know, but perhaps a bit more explication on this issue would be helpful.

The article does offer more detail, and what seems like useful advice, about how to talk to patients and how to work in conjunction with palliative care physicians.