Oncologists often miss opportunity to discuss end-of-life with patients, study finds

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Of 423 encounters between oncologists and patients, just 5 percent included end-of-life discussions, with oncologists often shying away from such conversations even when the opportunity presented itself, according to findings recently published in JAMA Network Open.

For the study, published June 10, researchers evaluated audio recordings of outpatient visits conducted between November 2010 and September 2014 at two U.S. medical centers. In all, 423 encounters involving 141 patients and 39 oncologists were included in the analysis. Patients included in the study were ones whom oncologists described as being patients whom they "would not be surprised if they were admitted to an intensive care unit or died within one year." 

Researchers defined a missed opportunity on end-of-life discussions as "lack of practitioner exploration of patient values, goals or preferences in response to a patient statement regarding cancer progression, death, or disease experience, despite an opening in the conversation where such a discussion would have been appropriate, or even necessary."

Of the 423 encounters, 5 percent (21) included end of life discussions on topics such as advance care planning, palliative care, discontinuation of disease-directed treatment, hospice care and after-death wishes, findings showed.

In a random sample of 93 encounters, 38 percent (35) included at least one missed opportunity. 

"Oncologists missed opportunities for these discussions when they responded inadequately to patient concerns about disease progression or dying, used optimistic future talk to address patient concerns, or expressed concern over treatment discontinuation," the study said. 

"There remains a need to address oncologists' sensitivity to EOL discussions, to avoid unnecessary EOL treatments," the research concluded. 

To view the full study, click here

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