An editorial published in the 25 October issue of The New England Journal of Medicine states that better planning and communication may improve symptoms, stress, and survival time, as well as lower health care costs at the end of life.

According to Dr Thomas J Smith, professor of oncology and director of Palliative Medicine at Johns Hopkins,  "Physicians are not as forthright as we should be with patients about their prognosis …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."  

The authors of the editorial,  Dr Smith and Dr Dan L Longo suggest that colleagues should:

• discuss palliative care with patients during initial talks about prognosis at the first physician visit
• discuss advance directives and hospice information (within the first three visits)
• have additional discussions of prognosis and coping (during periods when treatments change).

A reason for this could be that doctors are afraid such discussions could take away a patient's hope. Dr Smith says: "What they don't realise is that hope is impossible to extinguish, and palliative care discussions can help patients focus on a better quality of life," regardless of prognosis. He adds:  "We have to do a better job of helping patients plan their remaining lives."  

Dr Smith concludes that an important part of integrating palliative care is teaching health care providers ways to communicate issues surrounding end of life care. "Discussions with patients about how they are coping with their prognosis are not simple or easy," he says, "but we can begin by asking patients and their families what they want to know about their prognosis and doing this at each transition point in their care."  

Reference: ‘Talking with patients about dying’, Thomas J Smith, M.D and Dan L Longo, M.D New England Journal of Medicine, 25 October 2012, (367) p 1651-1652.