Making Important End-of-Life Discussions with Cancer Patients

Study finds less than half of cancer patients have a completed will.

Power of attorney privileges may not be enough to help cancer patients make end-of-life decisions.

In a study published recently in JAMA Oncology led by Johns Hopkins University, more than 2000 surveys indicated there has been a 40% increase in the loved ones of cancer patients acquiring power of attorney. However, there has not been a positive correlation in them discussing end-of-life preferences.

Power of attorney grants someone the power to make decisions in the place of someone who has become unable to soundly make their own decisions. Within the health care landscape, this grants a loved one the ability to make important end-of-life decisions for terminal patients, such as lessening aggressive treatment or removing them from hospital.

The research team has found that although more people are being granted this power - 58% in 2012 - less than half of cancer patients have a completed will and only 62% have had end-of-life discussions with their loved ones.

Although power of attorney increases the likelihood of a cancer patient living out the remainder of their lives in their own homes, or in hospice care (instead of a hospital), many still receive aggressive forms of treatment up until they die. In 2000, 7% of cancer patients had "all care possible" treatment in the last 2 weeks of their lives; in 2012, this number went up to 58%.

"We found that many cancer patients still do not communicate their preferences for end-of-life care, despite the potential benefits to patients' quality of life and caregiver bereavement," said Amol Narang, MD, a resident in the Department of Radiation Oncology and Molecular Radiation Sciences at The Johns Hopkins Hospital.

Patients who had living wills or discussed end-of-life decisions were twice as likely to withhold certain treatments at the end of their lives.

Critical end-of-life decisions can serve as a great comfort to a patient. As research seems to show that the power of attorney is not enough to prompt patients and their loved ones to have these critical discussions, researchers are now looking for other ways to improve communication between patients and their loved ones.

"We hope our findings renew efforts to encourage physicians and the public to have these critical end-of-life discussions," Dr. Narang said.