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Steps recommended for communications
EOL talks happen less than 40% of the time
A new policy statement issued by the American Society of Clinical Oncology (ASCO) offers guidance to physicians to initiate discussions about the full range of palliative care and treatment options soon after a patient is diagnosed with advanced cancer.1
a.CO's policy statement outlines essential elements of care for patients with advanced cancer and identifies barriers that currently prevent advance cancer care planning conversations between physicians and patients. The key elements identified by ASCO are:
Physicians should initiate candid discussions about prognosis with patients soon after an advanced cancer diagnosis. These conversations currently occur with less than 40% of patients with advanced cancer.
Quality of life should be an explicit priority throughout the course of advanced cancer care. Physicians must help patients understand their prognosis, potential risk and benefits of available treatments, and quality-of-life considerations. In cases in which active treatment is unlikely to extend survival, palliative care should be discussed as a concurrent or alternative therapy.
Clinical trial opportunities should be increased. Currently, very few patients with advanced cancer participate in trials due to strict eligibility criteria. Few trials address quality-of-life issues and other barriers. Increasing opportunities for these patients to potentially benefit from trials and to contribute to improving cancer care should be a high priority.
To address barriers to advanced care planning, ASCO recommends the following:
Emphasize advanced care planning in physician education and training programs.
Communication skills for discussing prognosis and care options should be emphasized both in oncologists' initial training and in continuing medical education.
For oncologists in practice, advanced cancer care planning should be a key part of ongoing quality improvement programs.
Palliative care should be incorporated into American Board of Internal Medicine oncology training and certification, and into oncology fellowship programs.
Increase opportunities for advanced cancer patients to participate in clinical research. Prioritize studies that do the following:
evaluate strategies to maximize quality of life for patients with advanced cancer;
examine potential ways to improve communication between oncologists and patients to ensure patients' care reflects individual goals and preferences;
assess which patients with advanced cancer are most likely to benefit from novel treatments and study how to overcome biological mechanisms that make their cancer resistant to available treatments.
Increase educational resources for patients with advanced cancer. To help guide patients through difficult patient-doctor discussions, ASCO has published a free booklet for patients with advanced cancer. To access a copy of the booklet, go to www.cancer.net, select "Coping" from the left navigational bar and scroll down to select "Advanced Cancer Care Planning."
1. Peppercorn JM, Smith TJ, Heift PR, et al. Individualized care for patients with advanced cancer. J Clin Onc. Online before print. Accessed online Jan. 31, 2011. Web: http://jco.ascopubs.org/cgi/doi/10.1200/JCO.2010.33.1744.