The DOI matches its Crossref record; 49 of the 50 references it cites were found in a registry or an index; none of the 18 sources its claims cite is checked for support yet.
Associations Between End-of-Life Discussions, Patient Mental Health, Medical Care Near Death, and Caregiver Bereavement Adjustment
Open accessAbstract
CONTEXT: Talking about death can be difficult. Without evidence that end-of-life discussions improve patient outcomes, physicians must balance their desire to honor patient autonomy against a concern of inflicting psychological harm. OBJECTIVE: To determine whether end-of-life discussions with physicians are associated with fewer aggressive interventions. DESIGN, SETTING, AND PARTICIPANTS: A US multisite, prospective, longitudinal cohort study of patients with advanced cancer and their informal caregivers (n = 332 dyads), September 2002-February 2008. Patients were followed up from enrollment to death, a median of 4.4 months later. Bereaved caregivers' psychiatric illness and quality of life was assessed a median of 6.5 months later. MAIN OUTCOME MEASURES: Aggressive medical care (eg, ventilation, resuscitation) and hospice in the final week of life. Secondary outcomes included patients' mental health and caregivers' bereavement adjustment. RESULTS: One hundred twenty-three of 332 (37.0%) patients reported having end-of-life discussions before baseline. Such discussions were not associated with higher rates of major depressive disorder (8.3% vs 5.8%; adjusted odds ratio [OR], 1.33; 95% confidence interval [CI], 0.54-3.32), or more worry (mean McGill score, 6.5 vs 7.0; P = .19). After propensity-score weighted adjustment, end-of-life discussions were associated with lower rates of ventilation (1.6% vs 11.0%; adjusted OR, 0.26; 95% CI, 0.08-0.83), resuscitation (0.8% vs 6.7%; adjusted OR, 0.16; 95% CI, 0.03-0.80), ICU admission (4.1% vs 12.4%; adjusted OR, 0.35; 95% CI, 0.14-0.90), and earlier hospice enrollment (65.6% vs 44.5%; adjusted OR, 1.65;95% CI, 1.04-2.63). In adjusted analyses, more aggressive medical care was associated with worse patient quality of life (6.4 vs 4.6; F = 3.61, P = .01) and higher risk of major depressive disorder in bereaved caregivers (adjusted OR, 3.37; 95% CI, 1.12-10.13), whereas longer hospice stays were associated with better patient quality of life (mean score, 5.6 vs 6.9; F = 3.70, P = .01). Better patient quality of life was associated with better caregiver quality of life at follow-up (beta = .20; P = .001). CONCLUSIONS: End-of-life discussions are associated with less aggressive medical care near death and earlier hospice referrals. Aggressive care is associated with worse patient quality of life and worse bereavement adjustment.
Overview
Integrity signals
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Claims the paper makes
36 Own result · 7 Not checked yet · 7 Own method · 4 Own interpretation · 1 No basis given
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Caregivers of patients with high QoL felt better prepared for the death (β=0.23, p=0.002)”
§ Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment > RESULTS > Bereavement Outcomes
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Rests on an assumption: Caregiver report accurately reflects the patient's quality of life near death.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Patients reporting discussions had lower performance status (59.5 vs. 65.7; p=0.003)”
§ Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment > RESULTS > Patient characteristics
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“while longer hospice stays were associated with better patient QoL (5.6 vs. 6.9; F=3.70, p=0.01)”
- Also stated in: § Patients’ Quality of Life at EOL · plain
“The inverse was true for hospice care, where patients’ QoL improved the longer they were enrolled, except for patients who received less than one week of services.”
§ Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment > Abstract > Results
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Rests on an assumption: Caregiver report accurately reflects the patient's quality of life near death.
- Also stated in: § Patients’ Quality of Life at EOL · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Caregivers of patients who received any aggressive care were at higher risk for developing a Major Depressive Disorder (AOR 3.37, 95% CI 1.12-10.13), experiencing regret (β=0.17; p=0.01), and feeling unprepared for the patient’s death (β=−0.30; p<0.001)”
§ Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment > RESULTS > Bereavement Outcomes
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“improvements in self-rated change in health (AOR 1.17, 95% CI 1.05, 1.29)”
§ Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment > RESULTS > Bereavement Outcomes
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Rests on an assumption: Caregiver report accurately reflects the patient's quality of life near death.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“123 of 332 (37.0%) patients reported EOL discussions before baseline.”
- Also stated in: § Patient characteristics · plain
“Overall, 123 of 332 (37.0%) patients reported having EOL discussions with their physicians at baseline.”
§ Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment > Abstract > Results
plainn = 332- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Rests on an assumption: Patient self-report accurately identifies whether an end-of-life discussion occurred.
- Also stated in: § Patient characteristics · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“complete a do-not-resuscitate order (63.0% vs. 28.5%).”
§ Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment > RESULTS > Mental health, treatment preferences, and advance care planning
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Rests on an assumption: Patient self-report accurately identifies whether an end-of-life discussion occurred.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Patients who reported EOL conversations were significantly (p≥0.001) more likely to accept that their illness was terminal (52.9% vs. 28.7%)”
§ Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment > RESULTS > Mental health, treatment preferences, and advance care planning
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Rests on an assumption: Patient self-report accurately identifies whether an end-of-life discussion occurred.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“higher risk for Major Depressive Disorder in bereaved caregivers (AOR 3.37, 95% CI 1.12-10.13)”
- Also stated in: § Bereavement Outcomes · plain
“Caregivers of patients who received any aggressive care were at higher risk for developing a Major Depressive Disorder (AOR 3.37, 95% CI 1.12-10.13)”
§ Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment > Abstract > Results
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § Bereavement Outcomes · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“As shown in table 2, EOL discussions were not associated with patients feeling “depressed,” “sad,” “terrified,” “worried,” or meeting DSM-IV-criteria for a mental disorder in propensity-weighted analyses.”
- Also stated in: § DISCUSSION · plain
“we found no evidence that they were significantly associated with increased emotional distress or psychiatric disorders.”
§ Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment > RESULTS > Mental health, treatment preferences, and advance care planning
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Rests on an assumption: Patient self-report accurately identifies whether an end-of-life discussion occurred.
- Also stated in: § DISCUSSION · plain
- It may state two separate claims as one. 6
- Probably not a substantial claim. 1
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Patients who received no aggressive care had a mean QoL score of 6.4, while patients who received 3 or more therapies had a mean QoL score of 4.6 (F=3.61, df=3, p=0.01).”
§ Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment > RESULTS > Patients’ Quality of Life at EOL
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Rests on an assumption: Caregiver report accurately reflects the patient's quality of life near death.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Patients who did not receive hospice had a mean QoL score of 5.6; those enrolled for one week or less had a QoL score of 5.6; and those enrolled for 2 months or more had QoL scores of 6.9 (F=4.04, df=3, p=0.008).”
§ Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment > RESULTS > Patients’ Quality of Life at EOL
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Rests on an assumption: Caregiver report accurately reflects the patient's quality of life near death.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Our findings must be interpreted within the context of an observational study that could not randomize terminally ill cancer patients to EOL discussions for ethical and logistical reasons.”
§ Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment > DISCUSSION
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Our study did not include interviews with doctors or audio-taped conversations.”
§ Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment > DISCUSSION
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“it is one of the most robust statistical methods available to correct for potential selection bias and confounding.”
§ Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment > DISCUSSION
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
None of the sources cited for this claim have been checked yet.
In the paper
“Physicians also often avoid EOL conversations, communicate euphemistically, are overly optimistic, or delay discussions until patients are close to death, perhaps because their own feelings of failure or loss.4,5,10,13,48,49”
§ Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment > DISCUSSION
What the sources say
- Not checked yetcites [4]
- Not checked yetcites [5]
- Not checked yetcites [10]
- Not checked yetcites [13]
- Not checked yetcites [48]
- Not checked yetcites [49]
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“EOL discussions may make patients more realistic about the benefits of aggressive therapies, and thereby reduce the likelihood that they receive intensive treatments near death.15,43”
§ Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment > DISCUSSION
What the sources say
- Not checked yetcites [15]
- Not checked yetcites [43]
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Rests on an assumption: Patient self-report accurately identifies whether an end-of-life discussion occurred.
The paper relies on this without support.
Patient self-report accurately identifies whether an end-of-life discussion occurred.
“Absent such independent validation, the accuracy of patients’ reported rates of discussions remains unknown”
“we do not know who initiated the conversation, when it happened, or what was said.”
The paper relies on this without support.
Caregiver report accurately reflects the patient's quality of life near death.
“In a post-mortem interview, research staff interviewed the formal/informal caregiver involved in the patients’ care during the final week of life to assess the patient’s QoL near death.”
“source of report for patient QoL”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Misunderstandings about prognosis are common16, 17, 18 and are associated with increased exposure to futile treatments.19, 20, 21, 22”
From 5th ESO-ESMO international consensus guidelines for advanced breast cancer (ABC 5) (2020) · cites this paper as [20]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Delivery of prognostic information and advance care planning are desired by patients, but occur infrequently.”
From Should there be an expanded role for palliative care in end-stage renal disease? (2010) · cites this paper as [10]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Advance care planning has been associated with earlier and increased use of hospice care [12–15], reduced intensive treatment and hospitalizations at the end of life [13, 15–18], and better quality of life in patients with cancer and caregivers [12, 19].”
From Mindfulness to enhance quality of life and support advance care planning: a pilot randomized controlled trial for adults with advanced cancer and their family caregivers. (2024) · cites this paper as [12]
Experimental — accuracy not yet measuredIn the citing paper
“Despite knowledge of poor survival after dialysis initiation, advance care planning occurs infrequently [9,10].”
From Should there be an expanded role for palliative care in end-stage renal disease? (2010) · cites this paper as [10]
In the citing paper
“ESRD patients who have end-of-life discussions with a healthcare provider are more likely to complete advance directives [9,10].”
From Should there be an expanded role for palliative care in end-stage renal disease? (2010) · cites this paper as [10]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment > Abstract > Results
“longer hospice stays were associated with better patient QoL (5.6 vs. 6.9; F=3.70, p=0.01)”
§ Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment > RESULTS > Patients’ Quality of Life at EOL
“Patients who did not receive hospice had a mean QoL score of 5.6; those enrolled for one week or less had a QoL score of 5.6; and those enrolled for 2 months or more had QoL scores of 6.9 (F=4.04, df=3, p=0.008).”
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Oncologists’ Attitudes Toward and Practices in Giving Bad News: An Exploratory Study
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Hope for the Best, and Prepare for the Worst
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“By acknowledging that death is near, patients, caregivers, and physicians can focus on clarifying patients’ priorities and improving pain and symptom management.(1,49)”
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Palliative and End-of-Life Care in the African American Community
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Psychiatric illness in the next of kin of patients who die in the intensive care unit
Siegel, M. D., Hayes, E., Vanderwerker, L. C., Loseth, D. B., & Prigerson, H. G. (2008) · Critical Care Medicine · doi:10.1097/ccm.0b013e318174da72 · Cited by 292 · cited 1×
“The bereavement literature has begun to explore the associations between patients’ place of death, the receipt of hospice care, and caregivers’ subsequent risk for psychiatric disorders.(17,39,40) Recent studies have shown that communication interventions in the intensive care unit can reduce psychological distress am…”
The Role of Chemotherapy at the End of Life: “When Is Enough, Enough?”
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“Physicians also often avoid these conversations, communicate euphemistically, are overly optimistic, or delay discussions until patients are close to death, perhaps because their own feelings of failure or loss.(4,5,10,13,47,48) Consistent with this hypothesis, patients with lower Karnofsky scores, higher symptom burd…”
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“Unfortunately, end-of-life discussions are often poorly documented in the medical record, and other studies have revealed that patients and caregivers recall of conversations are often discrepant.(9) Absent such independent validation, the accuracy of patients’ reported rates of discussions remains unknown, and we sus…”
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Necessary Collusion: Prognostic Communication With Advanced Cancer Patients
Helft, P. R. (2005) · Journal of Clinical Oncology · doi:10.1200/jco.2005.07.003 · Cited by 164 · cited 1×
“Physicians also often avoid these conversations, communicate euphemistically, are overly optimistic, or delay discussions until patients are close to death, perhaps because their own feelings of failure or loss.(4,5,10,13,47,48) Consistent with this hypothesis, patients with lower Karnofsky scores, higher symptom burd…”
“I'm Sorry To Tell You...” Physicians' Reports of Breaking Bad News
Ptacek, J. T., Ptacek, J. J., & Ellison, N. M. (2001) · Journal of Behavioral Medicine · doi:10.1023/a:1010766732373 · Cited by 162
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Peaceful Awareness in Patients with Advanced Cancer
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Paradoxes in Cancer Patients' Advance Care Planning
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“Others have shown that hospice is associated with better quality of life near death,(17) and reductions in bereaved caregivers’ risk of developing major depressive disorder.(18) To date, however, research has not examined whether end-of-life discussions are associated with patients’ medical care in the final week of l…”
Admission to intensive care unit at the end-of-life: is it an informed decision?
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Sullivan, A. M., Lakoma, M. D., Matsuyama, R. K., Rosenblatt, L. A., Arnold, R. M., & Block, S. D. (2007) · Journal of Palliative Medicine · doi:10.1089/jpm.2007.0189 · Cited by 76 · cited 1×
“Physicians also often avoid these conversations, communicate euphemistically, are overly optimistic, or delay discussions until patients are close to death, perhaps because their own feelings of failure or loss.(4,5,10,13,47,48) Consistent with this hypothesis, patients with lower Karnofsky scores, higher symptom burd…”
Ethnicity and end-of-life care: the use of feeding tubes.
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Communication and understanding of prognosis among stage IV lung and GI cancer patients
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“Absent such independent validation, the accuracy of patients’ reported rates of discussions remains unknown, and we suspect our results are a conservative estimate of the true point prevalence of end-of-life conversations.(9,42) In addition, it worth noting that our sample had disproportionately high rates of ethnic m…”
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Metadata
- Authors
- Wright, A. A.
- Affiliations
- Dana-Farber Cancer Institute (US)
- Corresponding author
- Wright, Alexi A.
- ORCID
- Wright, Alexi A.
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2008-10-08
- Volume
- 300
- Issue
- 14
- Pages
- 1665
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- PMC
- PMC2853806
- OpenAlex
- W2137401089
- Cited by
- 2,788
- References
- 50
- Citations by year
- 2026: 115 · 2025: 132 · 2024: 152 · 2023: 167 · 2022: 186 · 2021: 221 · 2020: 215 · 2019: 225 · 2018: 178 · 2017: 207 · 2016: 179 · 2015: 159 · 2014: 143 · 2013: 136 · 2012: 110
- FWCI
- 84.45
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (acceptedVersion)
- Funders
- McGill University
- National Institute on Aging (K24AG033640)
- National Institute of Mental Health (MH-63892, R01MH063892)
- National Cancer Institute (R01CA106370, CA106370, CA 92044343, T32CA009172)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Keywords
- end-of-life discussions, advance care planning, mechanical ventilation, cardiopulmonary resuscitation, hospice enrollment, advanced cancer, patient mental health, major depressive disorder, informal caregivers, quality of life, intensive care unit admission, physician-patient communication, patient autonomy
- MeSH terms
- Adaptation, Psychological, Aged, Attitude to Death, Bereavement, Female, Humans, Longitudinal Studies, Male, Mental Health, Middle Aged, Neoplasms, Physician-Patient Relations, Physician's Role, Quality of Life, Resuscitation, Terminal Care, Caregivers, Hospice Care, Terminally Ill, Advance Care Planning
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