Emotional numbness modifies the effect of end-of-life discussions on end-of-life care. Academic Article uri icon

Overview

MeSH

  • Boston
  • Comorbidity
  • Decision Making
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neoplasms
  • Prevalence
  • Risk Factors
  • Survival Analysis
  • Survival Rate

MeSH Major

  • Dissociative Disorders
  • Physician-Patient Relations
  • Terminal Care
  • Terminally Ill
  • Withholding Treatment

abstract

  • Overall, end-of-life (EOL) discussions are unrelated to psychological distress and associated with lower rates of aggressive care near death. Nevertheless, patients who report that they feel emotionally numb about their illness might encounter difficulties cognitively processing an EOL discussion. We hypothesized that emotional numbness would modify the effect of EOL discussions on the receipt of less aggressive EOL care. Data were derived from structured interviews with 290 participants in the federally-funded Coping with Cancer Study, a multisite, prospective cohort study of patients with advanced cancer followed-up till their death. Patients' reports of EOL discussions with their physician and emotional numbness were assessed at a median of 4.6 months before their death. Information about aggressive EOL care (i.e., ventilation, resuscitation in the last week of life, death in the intensive care unit) was obtained from postmortem caregiver interviews and medical charts. Main and interactive effects of EOL discussions and emotional numbness on aggressive EOL care, adjusting for potential confounds, were evaluated using multiple logistic regression. The likelihood of aggressive EOL care associated with having EOL discussions increased by a factor of nine (adjusted odds ratio=9.02, 95% CI 1.37, 59.6, P=0.022) for every unit increase in a patient's emotional numbness score. Emotional numbness diminishes a patient's capacity to benefit from EOL discussions. The EOL decision making may be more effective if clinical communications with emotionally numb patients are avoided. Copyright © 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

publication date

  • May 2013

has subject area

  • Boston
  • Comorbidity
  • Decision Making
  • Dissociative Disorders
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neoplasms
  • Physician-Patient Relations
  • Prevalence
  • Risk Factors
  • Survival Analysis
  • Survival Rate
  • Terminal Care
  • Terminally Ill
  • Withholding Treatment

Research

keywords

  • Journal Article

Identity

Language

  • eng

PubMed Central ID

  • PMC3511666

Digital Object Identifier (DOI)

  • 10.1016/j.jpainsymman.2012.04.003

PubMed ID

  • 22926093

Additional Document Info

start page

  • 841

end page

  • 847

volume

  • 45

number

  • 5