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A conversation many doctors won’t have

The New York Times, November 18, 2011
At Home and Hospice Care of Rhode Island, where she's a medical director, Joan Teno, MD, has grown accustomed to patients being admitted with no clear understanding of their condition or prognosis. "The oncologist has told them, 'It's time to take a holiday from chemo,'" she said. "It's a way not to have a conversation he or she finds hard to do." So the hospice staff has to explain, compassionately but directly, what the physician didn't say: that chemotherapy isn't working. That the cancer isn't curable or effectively treatable. That death is near. Is this too scary a discussion? Too apt to cause the patient grief or fear, or torpedo the family's hopes? A Swedish study of patients with terminal cancer, just published in The Journal of Clinical Oncology, provides a solid argument to the contrary.