Magazine article Clinical Psychiatry News

Timing of Discussions Is Important

Magazine article Clinical Psychiatry News

Timing of Discussions Is Important

Article excerpt

This is an important study that I documents the fact that early discussions about end-of-life care for patients with stage IV cancer are associated with decreased intensity of care at the end of life, and that the timing of the initiation of these discussions is very important and should happen earlier than it does much of the time.

This is not the first study to show that this communication is associated with decreased intensity of care (JAMA 2008;300:1665-73). However, this is an important study because it is the first to document that early discussions are important (prior to the last 30 days of life).

Moving end-of-life discussions closer to diagnosis definitely is realistic and the way this should occur. However, it is not an "either-or" situation. Early discussions don't mean that later discussions aren't necessary and important. Early discussions set the frame and make it easier to have later discussions if/when patients get worse.

There is a need for physicians to improve communication to make sure patients or their surrogates understand end-of-life discussions. Our challenge now is to find successful ways to teach these cornmunication skills to physicians and help physicians implement these discussions in clinical practice. …

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