Queen's prof calls for better communication with doctors, family members

Terminally-ill patients in Canada are poorly prepared to deal with end-of-life issues such as whether or not they will be resuscitated if they suffer a heart attack or other life-threatening medical complication, says Queen's University professor of Medicine Daren Heyland.

A national study led by Dr. Heyland, research director in the Department of Medicine at Kingston General Hospital, reveals that only one-third of the patients had even discussed with their physicians the possibility of receiving cardiopulmonary resuscitation (CPR). 

"And if they do have these discussions, elderly patients are ill-equipped to participate in such discussions and to make such decisions," says Dr. Heyland. "The majority of patients do not know much about the process or expected outcomes of resuscitation."

In the study, face-to-face questionnaires were administered at five Canadian hospitals to older patients with end-stage cancer and advanced medical diseases, and where possible to one of their family members. Participants were asked about their information needs regarding the use of CPR as a means of keeping them alive, as well as the decision-making process and the role they wished to play in making this decision. 

The Queen's study also underlines the important role of family members, who say they want to be informed and involved in the discussions and decision-making, he adds. Almost 60 per cent of patients and 81 per cent of family members prefer some degree of shared decision-making that includes the family member(s).

"Strategies that improve understanding of resuscitation in the hospital context and that foster discussions between patients, their family members, and physicians may improve the quantity and quality of communication and decision-making at the end of life," Dr. Heyland suggests.

The new findings are published in the September issue of the international journal CHEST, the publication of the American College of Chest Physicians. Also on the research team from Queen's are: Dianne Groll (Psychiatry/Medicine), Deb Pichora (Medicine), and Chris Frank (Geriatrics).

Dr. Heyland heads a national research group on palliative and end-of-life care initiatives located at Queen's and McMaster, with affiliates at other Canadian universities and hospitals. Funded by the Canadian Institutes of Health Research (CIHR), the five-year project began in 2004 and focuses on care in hospitals, intensive care units and home settings. 

This is one of five studies undertaken by the team. They are examining how satisfied patients are with their care; how they make decisions about the kinds of treatments they receive at the end of life; the importance of where they die; and how aware patients are of the course of their disease and the odds of recovery.