As the nation grapples with reining in health care costs, the survey also raises the issue of doctors offering expensive chemotherapy for terminally ill patients even when there's little chance it will work, Keating said. Other research has shown that the use of chemotherapy is increasing at the end of life, even for cancers generally considered unresponsive to the drugs, according to background information in the article.
"It may be that doctors are just not comfortable talking about something that is challenging, difficult and time consuming," Keating said. "It may also be that doctors are not reimbursed for these discussions but they are for ordering another CT scan or round of chemotherapy. The survey suggests to us that doctors may be throwing out another treatment but not helping the patient understand there is no cure."
Younger physicians were more likely than older physicians to have end-of-life discussions with patients, possibly indicating that current medical training places more emphasis on palliative care.
If doctors don't bring up end-of-life issues, patients need to bring it up with their physicians, making sure their wishes are known, Keating said. Hospice is comfort-oriented care, most often offered at home, for those who are terminally ill.
The U.S. National Cancer Institute has more on end-of-life care.
SOURCES: Nancy Keating, M.D., M.P.H., associate professor, medicine and health care policy, Brigham and Women's Hospital and Harvard Medical School, Boston; Len Lichtenfeld, M.D., deputy chief medical officer, American Cancer Society, Atlanta; Jan. 11, 2010, Cancer, online