Many doctors think that giving a patient bad news will have negative repercussions. But a study published Aug. 1 in the Journal of Clinical Oncology found that patients typically don’t respond the way doctors fear they might, debunking many of the myths that cause doctors to not initiate end-of-life discussions with terminal cancer patients.
In a related commentary, Thomas J. Smith, a medical oncologist and hospice and palliative medicine specialist at Johns Hopkins University in Baltimore, and his colleagues point out that patients who reported having end-of-life discussions weren’t more depressed or worried and also chose to have less aggressive end-of-life care, as well as more and earlier hospice enrollment.
Smith also notes that this finding supports earlier research which showed that a frank end-of-life discussion doesn’t take away hope, feel misleading, or offend patients. It also doesn’t decrease their survival. “What it does do is allow them to plan advance directives, plan trips, get their financial concerns in order, resolve any family issues, and make spiritual peace before they get too sick,” says Smith. “It also helps them take advantage of hospice and palliative care and decide whether they want to die intubated in the ICU [intensive care unit] or peacefully at home.”
So what can patients do? “Don’t be afraid to ask for information—in fact, insist on it,” says Smith. If the doctor is vague, Smith suggests patients pointedly request, “Help me understand from a planning perspective what to expect over the next six months or a year.”
Bad news is never easy to hear, but often it can come as a relief, says Smith. “A lot of times patients will say, ‘That’s bad, but it’s a lot better than I expected.’ ” And the more they know, says Smith, the more patients can set realistic goals for managing pain and for spending the time they have left.