The American Society of Clinical Oncology (ASCO) has released a new guideline that outlines best practices for cancer clinicians when communicating with patients and their families (online September 11, 2017; doi:10.1200/JCO.2017.75.2311).
ASCO convened a panel of medical oncology, psychiatry, nursing, hospice and palliative medicine, communications skills, health disparities, and advocacy experts to develop these consensus-based recommendations. The panel conducted a systemic review of existing literature (47 publications) from 2006 to 2016.
"Clinicians face a monumentally difficult task: to guide patients on what may be the scariest and most unpleasant journey of their lives. We need to preserve their hope while at the same time giving them accurate information," said Timothy Gilligan, MD, FASCO, co-chair of the ASCO Expert Panel that developed the guideline, in a press release (September 7, 2017). "Helping oncology clinicians improve their communication skills ultimately helps patients, and that is what is most important."
Key recommendations include in the guideline are as follows:
- Communication skills training programs should be available to oncologists at every level of practice. Such programs should emphasize role playing to develop skills, as well observation of patient interactions in order 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 patient 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 the patient, while also engaging patients 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 patient preferences.
- Clinicians should discuss patient concerns about cost of care. For patients who are concerned about cost of care, clinicians should work to understand and address the specific concerns directly or refer the patient and their family to a financial counselor or social worker.
- Clinicians should make patients aware of all treatment options, which may include clinical trials or palliative care alone for certain patients. For appropriate patients, such as those with incurable cancers, clinicians should also discuss the option of starting palliative care at the same time as cancer therapy.
"The recommendations can help doctors form a trusting relationship with patients that is characterized by empathy, honesty, and a human connection with the patient and family," commented Walter F Baile, MD, co-chair of the ASCO Expert Panel (September 7, 2017).—Zachary Bessette