44 45 In addition, we had comprehensive data on patients' performance status, physical functioning, quality of life, and many other psychosocial factors associated with end of life decision making, including patients' treatment preferences, awareness of terminal illness, and end of life discussions with physicians, 11 22 23 46 which are rarely available in other databases.
24 We also asked patients whether they recalled having an end of life discussion with their physician, 11 had a strong therapeutic alliance with their providers, 25 and had completed a living will, durable power of attorney, or do not resuscitate order (see web appendix).
In my own experience, not only do doctors tend to avoid end-of-life discussions with their aging patients, but caregiving adult children are often equally silent.
But such conversations cannot replace end-of-life discussions with doctors and nurses, who know about the potential benefits and harms of interventions like feeding tubes.
Doctors are reluctant to have end-of-life discussions with patients, and not just because they are uncomfortable with the subject or because they are afraid they may be taking away hope.
For example, in a study published in the Journal of the American Medical Association in October 2008, Boston researchers found that patients who had end-of-life discussions with their physicians "were more likely to accept that their illness was terminal, prefer medical treatment focused on relieving pain and discomfort over life-extending therapies, and have completed a do-not-resuscitate order".
In a study of patients with advanced cancer published in March 2009 in Archives of Internal Medicine, the costs of care during the last week of life were 55 percent higher among those who did not have end-of-life discussions with their doctors.
The Knowledge Cafe found that participants expressed more willingness to provide PC to their patients, increased sensitivity to the holistic needs of patients and families, and increased confidence in the initiation of end-of-life discussions with their colleagues.
It was Palin who charged that a provision of the law allowing Medicare to pay doctors for having end-of-life discussions with their patients would lead to government-run "death panels".
The control patients are asked about the number and content of their ACP or end-of-life discussions with their clinicians and families.
Our findings suggest that patients prefer a nuanced approach to truth telling when having end-of-life discussions with their physician.
