Physicians Discussing End-of-Life

The Chicago Tribune's Triage blog featured an interview last week with Dr. Martha Twaddle, chief medical officer of the Midwest Palliative & Hospice CareCenter, in response to new research showing that physicians do not discuss end-of-life issues with patients dying of cancer. Researchers followed 603 people with end-stage cancer, looking at the medical care they received and asking patients about conversations with their doctors.

Q. The researchers talk here of end-of-life discussions. What does that involve?

A. The doctor will say: ‘We don’t have anything left to treat the disease. So we need to talk about what you goals are and what is meaningful support for you and your family.’

Q. What happens instead when these discussions don’t occur?

A. The conversations revolve around the tasks at hand instead of the big picture. The doctor will say the results of your last scan showed this. The therapeutic interventions available to you are these. I think we should begin with such and such treatment or wait and see what the next scan shows and make a decision. It’s always about the next procedure or test. The focus is on the minutia as opposed to the person and their experience of the disease and what are the most likely outcomes.