Talking with patients about dying

In an editorial appearing in today's issue of the New England Journal of Medicine, medical oncologists at Johns Hopkins Hospital and Brigham and Women's Hospital present a four-point plan for integrating palliative care discussions throughout the treatment of patients with terminal illness.

Thomas J. Smith, the Harry J. Duffey Family Professor of Palliative Medicine, professor of oncology, and director of palliative medicine at Johns Hopkins, co-authored the editorial. He writes that patients are often too optimistic about their chances of recovery, which is supported by an article published in the same Journal issue showing that 69% of patients with lung cancer and 81% of those with colorectal cancer did not report understanding that chemotherapy was not at all likely to cure their cancer.

"Physicians are not as forthright as we should be with patients about their prognosis," Smith says in a Hopkins Medicine news release. "We do a fair job of communicating to patients that their terminal illness is incurable, but only one-third of doctors tell patients their prognosis at any time during their care."

In an [appearance on CBS This Morning earlier today], Smith said that the entire health care system would benefit if people were more honest about death.

From today's Journal article:

It is possible to tell patients more effectively that they have a terminal illness, a sharing of information that would enable them to better plan their remaining life. But they need help. Oncologists can help patients understand by giving personalized information. Nearly all patients want to know whether or not they can be cured, and the majority want to know their prognosis. An essential skill for practitioners is mastering the conversation known as "ask, tell, ask," which consists of asking patients what they want to know about their prognosis, telling them what they want to know, and then asking, "What do you now understand about your situation?"

Read more from New England Journal of Medicine