Timing of discussion is sensitive to patients

End-of-life discussions can begin when someone is diagnosed with a life-limiting illness, says James A. Tulsky, MD, director of the Palliative Care Center at Duke University Medical Center, in Durham, NC.

"Part of it is, it's very important to find out what the patient wants," he says. "You know, if you look at surveys of patients, they have very different preferences for when they want to talk about this. Some people say, 'As soon as I get diagnosed with metastatic disease, for example, I want to have a discussion about end of life.' Other people will say, 'Only when I am a few weeks away from death do I want to have a discussion about end of life.'"

Physicians are increasingly trained to ask patients questions and to listen to their answers.

"One of the things that we train people to do is to ask patients and to say to somebody, 'One of the things I would like to talk with you about is decisions you would face in the future, concerns about the future. Is now a good time to talk about this? Would you like to hear about prognosis? Would you like to hear what we expect to happen with this illness, or would you rather not? People will [sometimes] say, 'I'm not ready to talk about that right now.' And then that's their choice," Tulsky says.