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Patient/Physician Communication

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Physicians and terminal patients need to communicate better with each other about end-of-life care options

A pilot study of physicians and their patients with terminal cancer or end-stage congestive heart failure suggests that physicians and terminal patients need to improve their communication about end-of-life care options. The researchers interviewed 22 physicians and 71 of their patients about the conversations they had related to end-of-life care.

Physicians and patients varied in their agreement on discussions in four areas of communication, with least agreement on the more sensitive issues. Agreement ranged from lows of 14 percent for physician's knowledge of patient's stated preferences for pain management and preferred place of death to 92 percent agreement on the patient's primary diagnosis. They agreed only 35 percent of the time about whether the physician understood the patient's financial circumstances and 35 percent of the time about the doctor's understanding of the patient's religious/spiritual concerns affecting their end-of-life care choices.

Doctors and patients were more likely to agree on whether they discussed care options, including advance directives (59 percent), possible need for hospice care (69 percent), possible need for referral to skilled nursing facilities (75 percent), and possible need for referral to religious/spiritual support or psychological/social support services (70 and 61 percent, respectively).

Patients with less than a high school education were less likely than their more educated counterparts to agree with their doctors about what types of discussions had taken place.

The study was supported by the Agency for Healthcare Research and Quality (HS10871).

See "Lack of concordance between physician and patient: Reports on end-of-life care discussions," by Susan DesHarnais, Ph.D., M.P.H., Rickey E. Carter, Ph.D., Winnie Hennessy, R.N., M.S.N., and others, in the June 2007 Journal of Palliative Medicine 10(3), pp. 728-740.

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