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J Palliat Med. 2009 Jun;12(6):547-53. doi: 10.1089/jpm.2008.0254.

Doctor-patient communication about advance directives in metastatic breast cancer.

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  • 1Institute for Technology Assessment, Massachusetts General Hospital, Boston, USA.



Oncology providers often find it difficult to discuss end-of-life issues with patients and assume that patients are reluctant to think about the issues involved. This study examined whether or not patients with metastatic breast cancer had advance directives, and if so, with whom they discussed written plans for end-of-life decisions.


A cross-sectional sample of 32 women with metastatic breast cancer and their providers from two academic medical centers in the United States were surveyed at baseline and again 3 months later about advance directives, decision-making goals, and their expectations. After the baseline assessment, patients viewed a decision aid that discussed choices for treatment of metastatic disease. The patients' experience with advance directives in addition to associations between advance directives and patient preferences regarding end-of-life care, demographics, and clinical characteristics were analyzed.


At baseline, the majority of women had gathered information (75%) about or had written (66%) advance directives. These percentages increased at 3 months. Providers were only aware of the presence of an advance directive in a minority of cases (14%). Patients were more than three times as likely to talk to and share written plans with family and friends than with their providers.


The majority of patients gathered information about advance directives and had made written plans, yet few discussed these plans with their providers. Explicit discussion of advance directives and patient preferences regarding end-of-life care are lacking in this setting. Facilitation of doctor-patient communication about end-of-life care is needed in order to provide quality patient care at this difficult time.

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