The study focused on patients dying of cancer, but results apply across all chronic illnesses: a multicenter study suggests patients have a better quality of life towards the end if aggressive, life-prolonging measures are avoided and if they are able to die at home.

Physician engagement improves dying experience

Physicians who are able to remain engaged andpresentfor their dying patients by inviting and answering questions and by treating patients in a way that makes them feel that they matter as fellow human beings have the capacity to improve a dying patient’s , according to authors

Although some earlier research has focused on general aspects of end-of-life care, such as pain management and physician responsiveness, the specific factors that matter most to patients with terminal cancer and their families have not been fully explored, the researchers said.

The concept of quality of the in cancer patients has been underexamined in cancer medicine in the quest to develop newer, more advanced, and effective modalities of interventional cytotoxic therapies,” wrote Alan B. Zonderman, PhD, and Michele K. Evans, MD, of the National Institute on Aging in Baltimore, in an invited commentary.

In analyses, factors that predicted worse quality of life included major depression, panic disorder, and a high degree of worry, whilea sense of inner peacefulnessat baseline was associated with better quality of life at the end.

In the analysis considering the variance in quality of life, the researchers determined that, aside from intensive care stay and in-hospital death, factors that explained quality of life variance in a negative fashion were patient worry, feeding tube placement in the final week, and chemotherapy in the final week.

The researchers noted that alleviating patient anxiety and worry is potentially modifiable and should be a priority among caregivers and clinicians.

The therapeutic alliance between patient and physician was a less strongly influential predictor than the other factors, but should still be considered important, according to the researchers.

MedPage Today 2012