3 tips for talking to terminal patients about end-of-life care

Oncologists should have open conversations with terminal cancer patients about their prognosis and end-of-life care to help reduce symptoms of anxiety and depression, according to an editorial published in JAMA Oncology.

The editorial focuses on a pair of studies, published in JAMA Internal Medicine and JAMA Oncology, that followed 278 patients and 91 clinicians involved in the Serious Illness Care Program at Boston-based Dana-Farber Cancer Institute and two affiliated clinics. Researchers found patients involved in the communication quality-improvement intervention had half as many moderate to severe symptoms of anxiety and depression compared to a control group after 14 weeks, according to AMA Wire.

Based on these findings, the editorial's authors — Belinda E. Kiely, PhD, and Dr. Martin R. Stockler, researchers at the University of Sydney in Australia — discussed three ways oncologists can improve conversations around end-of-life care:

1. Talk to patients sooner. "Oncologists should initiate conversations about serious illness with patients who have a significant risk of dying in the foreseeable future" because "patients want, require and deserve to know what is coming," the authors wrote.

2. Broaden the conversation. Along with basic care preferences, oncologists should also talk to patients about their values and priorities in life.

3. Make conversation notes accessible to the entire care team. Information about these conversations "should be documented, accessible and flagged in the EMR to increase the accessibility to others involved in the patient's care," the authors wrote.

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