Information of imminent death or not: does it make a difference?

Area of Science:

• Palliative Care
• Oncology
• End-of-Life Studies

Background:

• End-of-life care for cancer patients requires careful consideration of patient autonomy and preferences.
• Understanding the impact of communication about prognosis is vital for improving quality of care.

Purpose of the Study:

• To investigate differences in end-of-life care between cancer patients informed about their imminent death and those who were not.
• To assess the association between receiving information about impending death and the quality of care received.

Main Methods:

• Retrospective analysis of 13,818 cancer deaths from a national quality register (2006-2008).
• Matched comparison of 1,191 informed patients and 1,191 uninformed patients using nonparametric statistical methods.
• Inclusion criteria: patients who retained decision-making capacity until shortly before death.

Main Results:

• Informed patients were more likely to receive parenteral drugs as needed (PRN), have families informed, die in their preferred location, and have families offered bereavement support.
• No significant differences were observed in symptom control, including pain, anxiety, confusion, nausea, and respiratory secretions, between informed and uninformed groups.
• The majority of patients (91%) had received information about their imminent death.

Conclusions:

• Informing cancer patients about imminent death is associated with improved end-of-life care and facilitates the principles of a good death.
• This communication strategy does not appear to increase patient distress, such as pain or anxiety.
• The findings support open communication regarding prognosis in palliative cancer care.