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End of Life Patients Benefit from Knowing their Life Expectancy

Posted Nov 03 2008 9:02pm

You’ve just received news that hit you right between the eyes—hard! Your doctor has delivered a diagnosis with a potentially fatal outcome. Treatments might help or they might not. Do you want the doctor to lay the facts on the line or would you prefer to embark on the treatment pathway while being kept in the dark about your chance of survival?

Sure, we hear the occasional story of a patient who was given only a year to live—five years ago. We know doctors can be wrong and odds can be beaten, that fighting the good fight sometimes results in a miraculous victory. Is that reasoning enough to warrant withholding negative possibilities from the patient? Does telling the patient that a cure is a long shot throw him into a depression and diminish the chances of curative success?

To the contrary, studies show that patients who have been told, in the face of a dire diagnosis, what their life expectancy might be are no more emotionally depressed than are those from whom such information is withheld.

I am all for giving a patient hope but I am totally against giving a patient false hope. False hope can, for instance, lead a patient to begin a new and debilitating chemo regimen when it has become obvious that he cannot survive longer than a month. Rather than living my last month in a weakened state, ill from futile chemo treatments, I would prefer to spend it in more meaningful ways, peacefully with my family, sharing remembrances and saying my goodbyes.

A study reported in the Journal of the American Medical Association this week revealed that 37 percent of the doctors surveyed did not tell patients how long they have to live, even when the patient asked. Often doctors are uncomfortable with such conversations, sometimes families don’t want the patient told and other times, even when told, there is a lack of understanding on the part of the patient and the family.

My friend, Rita, is an oncology nurse who often receives letters of thanks from family members for the care she has given a loved one. One expressed gratitude for Rita’s having answered honestly when asked how much time the young mother of two little boys might have left. Rita’s answer, that the woman probably had two good weeks remaining before she began to slip away, was important because a birthday party for one of the little boys was scheduled beyond that ‘good two weeks’ window of time. The family moved up the birthday celebration and the mother was able to participate in it.

It might seem that placing a limit on life expectancy would rob the patient of hope, but, in Rita’s experience, that is not the case. Instead, the reality gives hope for a good death, by providing the opportunity for the patient to tie up loose ends, whatever they may be, before death occurs. There is a peace and serenity, Rita says, that comes from knowing one has not left unfinished business.

I’ll go on record as saying that I want to know. I am a procrastinator and need a deadline (no flippancy intended) to give me the impetus to reach goals, finish projects and say what I need to say. So, I want my doctors to give me their best guess.

What are your opinions?

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