Patient-Clinician Communication: American Society of Clinical Oncology Consensus Guideline

Abstract

Purpose To provide guidance to oncology clinicians on how to use effective communication to optimize the patient-clinician relationship, patient and clinician well-being, and family well-being. Methods ASCO convened a multidisciplinary panel of medical oncology, psychiatry, nursing, hospice and palliative medicine, communication skills, health disparities, and advocacy experts to produce recommendations. Guideline development involved a systematic review of the literature and a formal consensus process. The systematic review focused on guidelines, systematic reviews and meta-analyses, and randomized controlled trials published from 2006 through October 1, 2016. Results The systematic review included 47 publications. With the exception of clinician training in communication skills, evidence for many of the clinical questions was limited. Draft recommendations underwent two rounds of consensus voting before being finalized. Recommendations In addition to providing guidance regarding core communication skills and tasks that apply across the continuum of cancer care, recommendations address specific topics, such as discussion of goals of care and prognosis, treatment selection, end-of-life care, facilitating family involvement in care, and clinician training in communication skills. Recommendations are accompanied by suggested strategies for implementation. Additional information is available at www.asco.org/supportive-care-guidelines and www.asco.org/guidelineswiki .

Intended and unintended consequences: Ethics, communication, and prognostic disclosure in pediatric oncology

“…The current study did not allow us to separate these issues. However, this does not diminish the importance of prognostic disclosure, an ethical responsibility of oncologists that is supported by parental preferences . Instead, this work highlights the importance of attention to all aspects of communication.…”

A Patient-Reported Outcome Instrument to Assess Symptom Burden and Predict Survival in Patients with Advanced Cancer: Flipping the Paradigm to Improve Timing of Palliative and End-of-Life Discussions and Reduce Unwanted Health Care Costs

“…Timely palliative care was consistently associated with improvements in advance care planning, patient and caregiver satisfaction, and lower health care use, but no association between palliative care and survival was observed . The PRO instrument, which can be used to repeatedly assess multiple patient domains, supports the recent ASCO guidelines that encourage physicians to discuss patient concerns, reassess goals and costs of therapy, and address EOLC issues continually through the course of care . However, as noted above, we did not assess the value of repetitive administration of the PRO over time.…”

Advancing the field of communication research in pediatric oncology: A systematic review of the literature analyzing medical dialogue

“…We envision these data will highlight specific areas for improvement in oncologist–patient/family dialogue, particularly with regard to the frequency of prognostic communication and the specific language used to share this information. Findings should be juxtaposed against consensus guidelines for provision of optimal communication to inform the development of pediatric‐specific guidelines for prognostic communication in the setting of disease relapse or progression. We then advocate for development of real‐time clinical intermediation and experiential training models to promote best practice prognostic communication guidelines, using multicenter randomized control trials to ascertain the efficacy of educational interventions on both quantitative and qualitative outcome measures, including successful application of optimal communication metrics and concordance between oncologist and patient/parent prognostic understanding, perception of therapeutic alliance, and overall satisfaction with communication quality.…”