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Should doctors tell patients when death is imminent?

Terminally ill people should be given an honest prognosis from their doctors. That philosophy is now firmly entrenched in medicine. But there is less dedication to the idea of informing patients when death is imminent because of fears that patients or their family members may not want to know.

A study published online this week suggests that healthcare professionals keep patients fully informed in the final days and hours of life. Researchers in Sweden examined 1,191 cases in which patients were informed of imminent death and a similar number in which patients were not informed.

The study showed no differences between the two groups regarding pain control, nausea, anxiety and other symptoms at the end of life -- most likely because these symptoms are unlikely to change in the week before death. But the patients who were informed were much more likely to have their preferences met regarding intravenous medications, such as morphine. They were also more likely to have died in their preferred place and their family members were more likely to be offered bereavement support and were prepared for the event.

“People vary about the extent they want to know the truth, if they want to know at all, and in their understanding of what constitutes telling the truth,” the authors wrote. But, they concluded: “Being informed about imminent death does not lead to more unrelieved pain and anxiety during the last week of life.”

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Doctors need to stay on top of the situation, however, in order to keep patients and family members informed, the study notes. The study appears in the Journal of Clinical Oncology.

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