WHEN IT COMES to making decisions about aggressive medical treatments for the terminally ill, a recent study suggests that if quality of life is the goal, less is actually more.


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The study, published in the Aug. 13 Archives of Internal Medicine, used data from the Coping with Cancer Study, which followed 396 terminally ill cancer patients from 2002 to 2008. Through questions asked to the patients and their caregivers, the study pinpointed nine factors that most influenced quality of life: intensive care stays, hospital deaths, patient worry, religious prayer or meditation, site of care, feeding tube use in the final week, pastoral care in the hospital, chemotherapy in the final week, and the relationship between patients and their physicians.

“There’s almost a dose-response relationship between aggressive medical procedures—like feeding tubes, ventilators and resuscitation—and impaired quality of life in the last week,” says Holly Prigerson, a psycho-oncologist at Dana-Farber Cancer Institute in Boston. “The single most important factor was whether a patient spent the final week in the intensive care unit (ICU) or at home.”

End-of-Life Resources

These services offer information about your options for end-of-life care.

On the flip side, a strong doctor-patient relationship was one of the most important factors that contributed to a better quality of life. “It is really important that patients feel their doctors respect them and see them as a whole person,” says Prigerson. “Patients don’t want to feel as though their doctor is abandoning them just because there are no more medical treatments left to give.”

Other factors that improved quality of life included the patients’ spirituality, their reported sense of peacefulness, and feelings of social support. “It’s more about spiritual care and interpersonal relationships at the very end,” says Prigerson. You can’t talk with a feeding tube in, and most patients think that it’s best to die peacefully among family, she says.

Straight Talk Can Empower Patients

Research suggests that frank end-of-life discussions can be good for patients.

These findings point to the value of advance care planning. “It’s important to figure out what your goals are,” says Prigerson. “If your goal is to live as long as humanly possible despite anything, that’s fine. But if you want to avoid an ICU death … it’s important to talk to your doctors and family and make sure your advance care planning is consistent with your goals.”​​