|
 “One thing we noticed is that many patients with advanced cancer had
not had these conversations,” said lead author Dr. Michael J. Green
of the humanities and medicine departments at Penn State College of
Medicine in Hershey, Pennsylvania.
“When we talked to the oncologists about it, a response we heard
again and again is, ‘it’s not appropriate at this time, it’s going
to make them anxious, take away their hope’,” Green told Reuters
Health.
He and his team set out to see if it was true that working through
end of life planning took away cancer patients’ hope or raised their
anxiety levels.
They used an interactive decision aid with audio and video elements
called “Making Your Wishes Known: Planning Your Medical Future,” (MYWK)
which is available online.
It includes education modules on common medical conditions that can
result in decisional incapacity, as well as medical treatments often
introduced in life or death situations. Patients can choose a
spokesperson, prioritize values and goals, match treatment options
with priorities and generate a printable advance directive document
articulating their wishes.
For the study, the researchers divided 200 advanced-stage cancer
patients with anticipated life expectancy of two years or less into
two groups. One engaged in advanced care planning with the online
tool, while the other used only a state-approved advance directive
form and American Hospital Association educational materials.
Those who used the MYWK online tool spent an average of 70 minutes
in their advance care planning, compared to 26 minutes in the
comparison group.
Before and after the advanced planning sessions, researchers
measured the patients’ anxiety, hopefulness and hopelessness with
validated questionnaires. Hopelessness levels have been linked to
suicide risk for the terminally ill, the authors note.
Neither group had a decrease in hope or an increase in hopelessness
after their advance care planning sessions, according to results in
the Journal of Pain and Symptom Management.
Anxiety levels decreased slightly for the MYWK group and stayed the
same for the comparison group. Knowledge of advance care planning
and feelings of self-determination increased slightly for both
groups.
“People worry about what’s going to happen, 'am I going to be a
burden, how are people going to know what I want',” Green said. “'If
I get sick how am I going to get the treatment that I want and not
get treatment I don’t want'.”
[to top of second column] |
Terminally ill people are often already thinking about death, so
there is little reason to avoid having an explicit conversation
about it, he said.
“Many health professionals suggest that (advance care planning) may
make patients anxious, however like this study there is no evidence
this is the case – there is some evidence suggesting the opposite,”
said Dr. Karen Detering of the Respecting Patient Choices Program at
Austin Health in Melbourne, Australia.
“In my experience I think the health care professionals often feel
helpless, and are often reassured when they see patients are helped
by (advance care planning),” Detering, who was not involved in the
new study, told Reuters Health by email.
“In our experience – only approximately half of the patients who are
offered and undertake (advance care planning) will complete formal
advance directives, but many others will have a useful discussion
regarding what they would want in the future,” she said.
Doctors who initiate these conversations can do a lot to decrease
patient stress and anxiety, but many physicians are hesitant and are
also pressed for time, he said. The MYWK decision aid was modeled on
what a conversation with your doctor should look like, he said.
“To have a meaningful conversation about these end of life concerns
takes a lot of time and physicians are incredibly busy, they often
put off initiating these conversations,” Green said.
The low levels of anxiety and hopelessness even before the planning
sessions were surprising, although they did not include patients
with severe depression, he said.
“The presumption of the medical profession is unless you tell us
otherwise we’re going to do everything,” Green said. “It does put
some responsibility on the patients to speak up and say what matters
to them.”
SOURCE: http://bit.ly/1Bdto8P Journal of Pain and Symptom
Management, online December 23, 2014.
[© 2014 Thomson Reuters. All rights
reserved.] Copyright 2014 Reuters. All rights reserved. This material may not be published,
broadcast, rewritten or redistributed. |
