Doctors fail to identify dying patients’ wishes
The latest published research from the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment concludes that attending physicians are no better at understanding their seriously ill patients’ care preferences than are first-year medical interns.1
Even though they have known patients longer and talked with them about prognoses, attending physicians were no more likely to know whether their patients wanted cardio-pulmonary resuscitation, or how willing they were to live with undesirable treatment outcomes such as chronic pain, permanent feeding tubes, or nursing home placement.
"The experienced physicians and the interns both had a weak understanding of patients’ perceptions of their own quality of life, and both groups had trouble predicting patients’ preferences for treatment," concludes lead author Ira B. Wilson, MD, MSc, of the New England Medical Center in Boston. "We should worry about this because if experience means anything, surely it should correlate with more commitment to talking with patients and more skill in doing so."
One possible solution identified in the article involves changing medical paradigms of physician-patient communication about end-of-life issues. "Perhaps what we need is more open and direct dialogue about the circumstances and conditions of death: what dying means to patients, what they hope for and fear. Such conversations are difficult for both physicians and patients. But by focusing on decisions such as CPR and ventilator dependence, we may be deflecting our attention away from the issues of greatest salience and consequence, and in the process fooling ourselves and confusing our patients," the authors write. The kind of direct dialogue the authors recommend seems to reflect what already happens in many hospices.
Reference
1. Wilson I B, et al. Is experience a good teacher? How interns and attending physicians understand patients’ choices for end-of-life care. Medical Decision Making 1997; 17:217-227.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content