December 17, 2008

Families want doctors to share bad news

Although many doctors worry about breaking bad news about seriously ill patients to their kin, most family members want to know the truth, a study published suggests.

Research has shown that many doctors hesitate to be fully open with critically ill patients and their families -- opting, for example, to give a more optimistic estimate of life expectancy, or to not discuss prognosis at all unless the patient brings it up.

One reason for the reluctance, studies suggest, is that doctors worry about erasing hope for patients and their families.

However, in the new study published in the Annals of Internal Medicine, 93 percent of family members of critically ill hospital patients said that avoiding discussions about prognosis "was not an acceptable way to maintain hope."

Instead, families said that "timely discussion" about prognosis was essential for them to prepare, emotionally and practically, for the possibility that their loved one would die.

According to Latifat Apatira and colleagues at the University of California, San Francisco, the study supports the belief that doctors should help families "hope for the best and prepare for the worst."

The findings are based on interviews with 179 family members of seriously ill intensive-care patients; all had been placed on a ventilator because they could not breathe on their own.

When asked, the vast majority of family members said that withholding prognostic information was unacceptable. Only six study participants thought that doctors should do so if they thought the prognosis would be emotionally damaging to the family or further harm the patient's health.

The findings, Apatira's team writes, show that family members generally feel they are "resilient enough to hear news of a poor prognosis and also need this information to begin to come to terms with the possible death of a loved one."

They say that further studies should look at how doctors can "best balance" the task of being truthful about prognosis while giving families the emotional support they need.

SOURCE: Annals of Internal Medicine, December 16, 2008.

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