DEAR DOCTOR K:
My mother has advanced cancer and has only a few months to live. How can we help her live out her remaining days with as little pain and as much peace as possible?
Sadly, as in your mother’s case, there are times when cancer takes hold and doesn’t let go. In that situation, palliative care can help maintain quality of life and lead to a “good death.”
Palliative care focuses on both emotional and physical needs. It makes relief of pain and suffering a top priority. It also provides active support to loved ones and caregivers, including information about how to take care of someone at home.
A recent study conducted by Harvard-affiliated researchers surveyed almost 400 men and women with advanced cancer a few months before they died. Their caregivers were also asked about the person’s end-of-life experience.
The study found that human connection, rather than heroic life-saving efforts, mattered most to patients and their families. Though doctors mean well, we sometimes have a hard time accepting a person’s decision to stop treatment. As a result, we may strongly lobby for one more try.
You can work on your mother’s behalf to help her doctors understand what she does — or doesn’t — want. And we as doctors need to help our patients make decisions that are right for them.
There are other things you can do and advocate for as well. Patients and families who participated in the study mentioned the following as things they considered important for maintaining good quality of life at the end. These are the things that helped patients end their days as peacefully as possible:
- Being at home instead of in the hospital;
- Not undergoing chemotherapy or other active cancer treatment;
- Having adequate relief of pain;
- Not having a feeding tube;
- Talking with a chaplain or other minister, and spending time in private religious activity;
- Having a good relationship with the health care team.
Most, but not all, of my patients want to be entirely in control of decisions made about their medical care. That is particularly true if they have a life-threatening condition. They want to know what their options are — and the benefits and risks of each option. They understand that the best we doctors can do is give them estimates. If their condition is incurable, they want an estimate of how much longer they might live with a particular treatment. And they want to know what symptoms they might suffer both without treatment and from the treatment.
After they get this information, they want to make the decision about what to do, based on their assessment of their situation and their values. They often discuss this with the family and friends they trust before making their decision.
In the end, many choose palliative care. To learn more about it, visit the Center to Advance Palliative Care website, at www.capc.org.