For patients with terminal illnesses such as cancer, discussing with their doctors whether to resuscitate, when to seek hospice care, and where to spend the last days of their lives, can actually empower them and help them gain some control over treatment and over the final stage of their lives.

National guidelines recommend that these discussions should be initiated by doctors whenever a patient has less than one year to live. They should include clear and consistent discussions about prognosis (what the doctor predicts will happen), information regarding advanced directives, exploration of the "do not resuscitate" (DNR) option, information about palliative care options such as hospice care, and obtaining information about patients’ preferences for site of death. In California, a recently enacted legislation requires doctors to counsel patients who have less than one year to live about hospice and palliative care.

An advance directive tells the doctor what kind of care the patient would like to have if he/she becomes unable to make medical decisions (such as in a coma, for example). Palliative care focuses on relief of the pain, stress and other debilitating symptoms of serious illness. Hospice care includes medical, psychological and spiritual support for the patient and his/her family members and its goal is to help dying patients have peace and dignity by controlling pain and other symptoms so they can remain as alert and comfortable as possible. A DNR is a request not to have cardiopulmonary resuscitation (CPR) if the patient’s heart stops or if he/she stops breathing.

A new study published in the journal Cancer reports that most doctors are hesitant to discuss end-of-life care with terminally-ill patients, especially when these patients are feeling well or when some treatment options are still available. The study asked 4,074 doctors about what they would say in a hypothetical situation of a cancer patient that has only four to six months to live. According to the results, “65% of physicians would discuss prognosis 'now,' whereas 15% would have this discussion only if the patient/family brings it up. Approximately 44% would discuss DNR status 'now,' with 18% waiting for the patient to have symptoms and another 26% waiting until there were no more non-palliative treatments. Approximately one–quarter (26%) of physicians would discuss hospice 'now,' with 16% waiting for symptoms and 49% waiting until there are no more non-palliative treatments. Finally, 21% would discuss preferred site of death 'now,' with 24% having this discussion only if the patient/family brought it up.”

Several factors can help explain these results. Some doctors disagree with the guidelines while others may be unaware of them. But even those who agree with the guidelines may they still delay discussions for other reasons. For example, some doctors may delay end-of-life discussions because they worry that discussing death early may give the patient less hope and thus result in poorer outcomes. Others may have difficulty because they think that discussing end-of-life issues is an admission of personal failure to cure the patient’s cancer.