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Special Communication
Sharing Medicine
September 2017

A Research Agenda for Communication Between Health Care Professionals and Patients Living With Serious Illness

Author Affiliations
  • 1Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
  • 2Division of Palliative Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
  • 3Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
  • 4Psycho-Oncology Co-Operative Research Group, Centre for Medical Psychology and Evidence-Based Medicine, School of Psychology, University of Sydney, New South Wales, Australia
  • 5School of Nursing, Indiana University, Indianapolis
  • 6Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
  • 7Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
  • 8Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
  • 9Baylor College of Medicine, Houston, Texas
  • 10Department of Communication, Texas A&M University, College Station
  • 11Division of Geriatrics, Department of Medicine, University of California–San Francisco
  • 12San Francisco Veterans Affairs Medical Center, San Francisco, California
  • 13Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
  • 14Cancer Control and Population Sciences, Duke Cancer Institute, Duke University, Durham, North Carolina
  • 15Department of Community and Family Medicine, Duke University, Durham, North Carolina
JAMA Intern Med. 2017;177(9):1361-1366. doi:10.1001/jamainternmed.2017.2005
Abstract

Importance  Poor communication by health care professionals contributes to physical and psychological suffering in patients living with serious illness. Patients may not fully understand their illness, prognosis, and treatment options or may not receive medical care consistent with their goals. Despite considerable research exploring the role of communication in this setting, many questions remain, and a clear agenda for communication research is lacking.

Observations  Through a consensus conference and subsequent activities, we reviewed the state of the science, identified key evidence gaps in understanding the impact of communication on patient outcomes, and created an agenda for future research. We considered 7 broad topics: shared decision making, advance care planning, communication training, measuring communication, communication about prognosis, emotion and serious illness communication, and cultural issues. We identified 5 areas in which further research could substantially move the field forward and help enhance patient care: measurement and methodology, including how to determine communication quality; mechanisms of communication, such as identifying the specific clinician behaviors that patients experience as both honest and compassionate, or the role of bias in the clinical encounter; alternative approaches to advance care planning that focus on the quality of serious illness communication and not simply completion of forms; teaching and disseminating communication skills; and approaches, such as economic incentives and other clinician motivators, to change communication behavior.

Conclusions  Our findings highlight the urgent need to improve quality of communication between health care professionals and patients living with serious illness through a broad range of research that covers communication skills, tools, patient education, and models of care.

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