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Less is often more in the last phase of life

Physicians should be more aware of the medication and other treatment provided to patients as they approach the end of life. This is one of the findings presented in the thesis of trainee internist/oncologist and clinical pharmacologist Eric Geijteman, who received his PhD for his unique research on 12 December.

Geijteman studied current practice regarding end-of-life decisions. The study shows that patients with a limited life expectancy, because they have an incurable cancer, for example, are often subjected to potentially unnecessary or harmful medical interventions.

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For his study, the PhD student included data from mortality studies, retrospective patient file reviews, questionnaire studies, and an interview study. He concluded that physicians often continue treatment due to a lack of clear guidelines, and because too little research has been conducted, in particular, on the effects of stopping medication.

“Physicians are uncertain what to do. However, it would do no harm if they were to carefully check the list of medication being administered to their patients nearing the end of their lives. If you know that someone is about to die of a terminal illness, is there any point in giving him/her medication for high blood pressure or cholesterol? All drugs have side effects. In addition, it is often a great burden for patients to have to take a large number of pills several times a day.”

This is why Geijteman calls for more research on the effects of stopping the drugs that are assumed to be unnecessary. He urges colleagues to become more aware of the fact that medical interventions are not always in the patient’s best interest. “Physicians can abandon the credo ‘we have done everything we can to stop him/her dying’. And instead aim to: ‘not go too far in trying to stop the inevitable death of the patient.’ Discuss the situation with the patient promptly, and involve the patients and their relatives in end-of-life decisions.”

He also has a message for patients. “Be aware of the limitations of healthcare. Physicians can’t do everything, and less end-of-life care is in some cases better care. It is also important that you don’t postpone thinking about the last phase of your life too long. How do you want to be cared for? Discuss this with your physicians and loved ones.”

The ultimate goal of Geijteman’s study is to contribute to improving end-of-life care, and providing a better death for terminally ill patients. “Not just for the patients themselves, but also for their relatives. Relatives should not be left feeling that physicians continued providing treatment for too long; treatment that would actually bring no benefit.”

Date published: 12 December 2018.

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