Discussions about end-of-life issues between patients, doctors and families improve the quality of life for the terminally ill. They also have “cascading benefits” for both patients and their loved ones, according to new research.

Researchers interviewed 332 terminally ill cancer patients and their loved ones to determine what impact, if any, these end-of-life discussions have on overall quality of life. Patients who remember having an end-of-life discussion with a physician or family member are three times less likely to wind up in intensive care, four times less likely to be put on a ventilator, and six times less likely to undergo resuscitation, according to report author Dr. Alexi A. Wright with the Dana-Farber Cancer Institute in Boston.

More aggressive end-of-life care, including stays in the intensive care unit and resuscitation during the last week of life, were associated with reduced quality of life for not only the patient, but the family as well. Family members who witness aggressive end-of-life care are three times more likely to develop serious depression after the death of a loved one, according to the report. The research appears in the October 8 issue of the Journal of the American Medical Association.