title: Emotional numbness modifies the effect of end-of-life discussions on end-of-life care.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Paul K
authors.initials: PK
authors.lastname: Maciejewski
authors.forename: Holly G
authors.initials: HG
authors.lastname: Prigerson
mesh_terms: D001900:Boston / Q000453:epidemiology; D015897:Comorbidity; D003657:Decision Making; D004213:Dissociative Disorders / Q000453:epidemiology* / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality / Q000523:psychology; D010817:Physician-Patient Relations; D015995:Prevalence; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D013727:Terminal Care / Q000523:psychology* / Q000706:statistics & numerical data*; D019452:Terminally Ill / Q000523:psychology* / Q000706:statistics & numerical data; D028761:Withholding Treatment / Q000706:statistics & numerical data*