Intended for healthcare professionals

Rapid response to:

Opinion

Death and the bogus contract between doctors and patients

BMJ 2022; 377 doi: https://doi.org/10.1136/bmj.o1415 (Published 07 June 2022) Cite this as: BMJ 2022;377:o1415

Rapid Response:

Tender conversations and when palliative care can prolong life

Dear Editor,

Richard Smith calls these conversations 'difficult'. Kathryn Mannix a palliative care doctorin her book Listen has suggested we call them 'tender conversations' , they can cause pain to patient and doctor but if conducted well can be a healing experience.

Jennifer Temel and several others 'at Massachusetts General hospital researched early palliative care in 2010 'Early Palliative Care for Patients with Metastatic Non–Small-Cell Lung Cancer https://www.nejm.org/doi/full/10.1056/NEJMoa1000678

Patients with Stage four lung cancer patients lived on average, 11 months. It is a terminal condition; no one lived past about three years. Dr Temel randomised half of the group to get the usual oncology care, and the other half were randomized to get the usual oncology care plus a palliative care clinician, a physician, to see them early in the course of their illness. It was considered a radical idea — see them from the very beginning.

And the group who saw the palliative care clinicians from the very beginning did end up stopping their chemotherapy. They were 50 percent less likely to be on chemotherapy in their last three months of life. They were 90 percent less likely to be on the chemotherapy in their last two weeks of life. They were less likely to get surgery towards the end. They had one-third lower costs. They started hospice sooner. They spent more time out of the hospital. They were less likely to die in the hospital or die in the ICU. And the kicker was that they not only had overall less suffering, they lived 25 percent longer.

Competing interests: No competing interests

04 August 2022
Katherine E Burn
Undergraduate Teacher and GP
Univeristy of Central Lancashire
Blackburn