Terminally ill patients do not experience increased anxiety or pain upon being informed of their imminent death, according to a new study by Swedish researchers.
In fact, not only is the information not detrimental, but it also contributes to a better experience with death overall, the results showed. While people's request for information varies, knowledge of their impending deaths allows many patients to exert control over the final experience. They are much more likely to be able to decide how their medications should be administered, who will be present with them in the last moments, and where their deaths will take place. Bereavement support is also more readily offered to their loved ones, with everyone better prepared for the event.
Cancer Patients Open up about Their Situation
Published online this week in the Journal of Clinical Oncology, the study examined whether giving cancer patients an honest prognosis about their upcoming death would have an impact on the quality of their end-of-life care.
The researchers compared 1,191 patients who were informed that they were dying with an equal number of uninformed patients to assess possible physical and emotional differences between the two related to having been given the sensitive information. Specific controls were in place to evaluate changes in pain, nausea, respiration, and anxiety.
Informed patients were significantly more likely than their uninformed counterparts to be prescribed parenteral drugs, such as morphine, as needed, to have their families also knowledgeable about the upcoming death, and to die in their preferred place. There was also no difference in the amount of respiratory tract secretions between the two groups; thickening of such secretions frequently occurs during the final stages of life as dying patients cannot cough or swallow to drain and dilute the fluids. Parenteral drugs refer to those given outside the digestive tract, such as through veins or injections. Such administration methods provide immediate support for terminal patients as they usually cannot swallow or digest medications. By receiving parenteral treatment PRN, which means on an as-needed basis, patients and their families gain decision-making authority.
Patients Prefer To Be Informed
Study authors concluded that knowing death will occur within the next few days does not contribute to increased pain and anxiety and does not reduce the quality of end-of-life care. They suggested that health-care providers stay focused on patients' statuses to be able to continue informing them and their loved ones of the situation as it progresses. They also suggested that the findings support the principle that such information contributes to 'a good death', a philosophy espoused by those caring for dying patients.
Presently, informing patients about their prognoses, even when the news is grim, is a standard practice among health-care professionals. Accomplishing that ideal becomes more complicated, however, as physicians must first weigh whether or not and how much information the patients and their families want.
Various factors influence people's desire to learn more about their conditions. For some religious and spiritual beliefs preclude the need to attain scientific information, whereas for others, educational level and ability to comprehend complex terminology dictates how much information they ask for and are able to understand. Ultimately, many doctors recognize that the key to a peaceful end-of-life experience is acknowledging patients' emotions and identifying their individual needs.
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Date of original publication: April 09, 2013