News

This is an excerpt of a story that appeared in the New York Times. Read the full article here.

We’ve known for years that doctors hesitate or even decline to discuss a poor prognosis with patients and their families. They fear that bad news will dash hopes; they don’t want to appear to be giving up. Often, their training hasn’t prepared them for sensitive conversations.

...

Dr. Holly Prigerson Yet the supposed cornerstone of contemporary medicine — patients making informed decisions — depends on their understanding their situation, their life expectancy, their probable quality of life, the pros and cons of any proposed treatment. (Or, when patients themselves are incapacitated, it depends on their surrogate decision makers’ understanding.)

Experts have urged doctors to talk about the elephants in the room, especially at the end of life. But two recent studies show how achingly slow progress has been.

Even terminally ill patients still receive scant information, researchers have found, while family members acting for I.C.U. patients commonly contend with confusion and misinformation. The studies also uncover some reasons for the disconnect. Doctors, it seems, shouldn’t get all the blame.

Dr. Holly Prigerson, director of the Center for Research on End-of-Life Care at Weill Cornell Medicine, and her colleagues interviewed 178 patients at cancer centers across the country. All had cancers that had progressed despite chemotherapy; their oncologists estimated their life expectancy at less than six months. “These patients were all dying, and everyone treating them was well aware of it,” Dr. Prigerson said.

Yet nearly 40 percent said they’d never discussed prognosis or life expectancy with their oncologists. Not surprisingly, when asked to answer four key questions about how well they understood their illness — including whether they grasped that their cancer was incurable and that they had months, not years, to live — only 5 percent answered correctly.

Frank discussions don’t disrupt the bond between doctors and patients, Dr. Prigerson has shown. They do increase the likelihood that patients receive the end-of-life care they prefer, and leave survivors better able to cope with grief.