Last modified: Monday, June 23, 2008 5:43 PM EDT SHEA-TAYLOR: Truth about life's ending Do you or do you not want the truth? If your answer is yes, will you receive it? Then what? Only one-third of 603 terminally ill cancer patients from Massachusetts, New Hampshire, Connecticut and Texas in a new, federally funded study, said their doctors had discussed end-of-life care. This would include hospice, which delivers comfort with pain-relieving drugs and with compassion, its mission caring instead of curing. The reported gaps in doctor-patient candor need attention. Hospice can replace extreme measures which may keep a terminally ill patient tangled up indefinitely in the heroics of life-sustaining interventions. But before decisions can be made on end-of-life care, patients require information on options, that missing link in some doctor-patient relationships. "Surprisingly, patients who had these talks were no more likely to become depressed than those who did not," the study found, as reported last week by Associated Press. "They were less likely to spend their final days in hospitals, tethered to machines. They avoided costly, futile care. And their loved ones were more at peace after they died." This may be because there is substantial empathic support from hospice as families engage with loved ones whose illness is beyond remedy. There are dozens of hospice providers in Massachusetts, including Community VNA Hospice Care in Attleboro. The economic value of hospice care has been validated. An independent study by Duke University found that use of hospice saved Medicare an average of $2,300 per patient who received this care. Still, the Bush administration announced in April a plan to slash hospice reimbursement rates and providers are scrambling to both fight this budget absurdity and muster fund-raising plans in an attempt to maintain programming levels. Can anyone explain what sense it might make to cut funding to a program that has proven to work so effectively and efficiently? Hospice, the name rooted in the word hospitality, was instituted in this country just 34 years ago with the founding of the Connecticut Hospice. Congress in 1986 made permanent the Medicare Hospice Benefit of 1982 and accorded a 10 percent increase in reimbursement rates. States are given the option of including hospice in their Medicaid programs. Hospice care is now available to terminally-ill nursing home residents. More than 1.3 million dying Americans received care from the nation's hospice providers in 2006, a 162 percent increase over a decade, reports the organization. This number continues to grow as more patients learn of the wide range of beneficial services. Hospice is considered to be the model for high-quality care at the end of life. It involves a team-oriented approach that includes expert medical attention, pain-and-symptom management, and emotional and spiritual support. The quality of a person's life is emphasized, not the duration. Moreover, services and support are also provided to family caregivers. Most hospice care in this country is delivered in the patient's home, the rest in hospitals with hospice beds and in free-standing hospice facilities. One such facility is under development in Providence. The new federal study on doctor candor, AP reported, is the first to look at what happens to patients if they are or are not asked what kind of care they'd like to receive if they were dying, said lead researcher Dr. Alexi Wright of the Dana-Farber Cancer Institute in Boston. As more doctors take the direct approach in relaying chances for survival, it's certain that demand for hospice services will increase. The government should ensure expansion, not contraction of services. How could anyone think differently? BETSY SHEA-TAYLOR, a former editor and writer for The Sun Chronicle, is a freelance writer and a hospice home visitor.