Emotional numbness modifies the effect of end-of-life discussions on end-of-life care

Abstract

Context: 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.

Objectives: We hypothesized that emotional numbness would modify the effect of EOL discussions on the receipt of less aggressive EOL care.

Methods: 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.

Results: 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.

Conclusion: 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.

Conflict of interest statement

Disclosures

Neither author has relationships with any entities having financial interest in this topic.

Copyright © 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

Figures

Fig. 1

Patient emotional numbness modifies relationship between EOL discussions and aggressive EOL care (N=290). Predicted odds of aggressive EOL care adjusting for age and race (White versus non-White).