When there's no more that can be done for terminally ill patients, and the focus of care turns to keeping them comfortable before death, many feel as if their doctors have abandoned them, new research finds.
But for doctors, the dying and their families, continuing care is helpful for all concerned, and it helps provide a sense of closure for the family and for the doctor.
"The therapeutic part of the doctor-patient relationship extends to the end-of-life, and it's even more important then to honour that relationship," said study author Dr Anthony Back, a professor in the department of medicine at the Fred Hutchinson Cancer Research Center, in Seattle, USA.
Results of the study were published in the March 9 issue of the Archives of Internal Medicine.
According to background information, an important aspect of end-of-life care that's emphasised in expert guidelines is making sure that patients don't feel abandoned. But, how this actually works out in practice hasn't been well-studied.
The research study
Back and his colleagues recruited 31 physicians who were able to identify 55 people in their care who they felt would likely die within a year. All of the patients had either terminal cancer or advanced chronic obstructive pulmonary disease.
The researchers interviewed doctors, nurses, those who were dying and their caregivers at the start of the study, then again four to six months later, and then again at a year.
"A number of patients and families did feel that they were abandoned by their doctor," said Back. "I'm not sure that the doctors realised they felt this way. Doctors felt a lack of closure with these patients, but felt it was something that just affected them. They weren't sure how additional contact would help."
Most doctors not sufficiently trained
Back said that most doctors haven't been trained in dealing with end-of-life issues. Time constraints are also a factor.
But, he said, "even though the medical care system doesn't reward doctors for this type of care, many times when doctors do make these kinds of contacts, they find them very rewarding."
"Even just a phone call or two to check in is tremendously important to the family to let them know you're still paying attention," said Back.
"This is an area that the health-care profession is becoming much more mindful of," said Dr Sean O'Mahony, medical director of palliative care at Montefiore Medical Center in New York City. "This study emphasises that patients and caregivers attach value to how we communicate and how we end professional relationships with patients when that patient needs to transition to another care centre."
(HealthDay News, April 2009)