Recommendations From ASCO for Discussing Patients’ Goals of Care Through Survivorship to End of Life
In 2017, ASCO published its consensus guideline to provide guidance on how oncologists can use effective communication to maximize the patient-clinician relationship, patient and clinician well-being, and family well-being as well as form a trusting relationship with patients through empathy and honesty. Here are six key recommendations from the guideline. For a complete summary of the recommendations, visit www.asco.org/sites/new-www.asco.org/files/content-files/practice-and-guidelines/2017-patient-physician-comm-summary-table.pdf.
Communication skills training programs should be available to oncologists at every level of practice. Such programs should emphasize roleplaying to develop skills as well as observing patient interactions to provide feedback to clinicians.
Clinicians should clearly establish care goals with patients and ensure that patients understand their prognosis and treatment options. Care goals and the treatment decisions based on these goals should align with patients’ values and priorities.
Clinicians should partner with patients by encouraging them to discuss concerns and participate in deciding what is discussed during each visit. Such collaboration fosters trust and confidence for patients while also engaging them to take an active role in their care.
Clinicians should initiate conversations about patients’ end-of-life preferences early in the course of incurable illness and raise the topic for discussion periodically, based on symptoms, disease progression, and patients’ preferences.
Clinicians should discuss patients’ concerns about the cost of care. For patients concerned about the cost of cancer care, clinicians should work to understand and address the specific concerns directly or refer patients to a financial counselor or social worker.
Clinicians should make patients aware of all treatment options, including clinical trials or palliative care alone. For appropriate patients, including those with incurable cancers, clinicians should also discuss the option of starting palliative care at the same time as cancer therapy.
Source: Gilligan T et al: J Clin Oncol 35:3618-3632, 2017.
Although studies have shown that patients with advanced cancer want their oncologists to discuss their advance care plans with them, fewer than half of those patients have that conversation. The reasons are many, including the difficulty many oncologists have in initiating conversations about...