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November 2016

Physician-Patient Communication—An Actionable Target for Reducing Overly Aggressive Care Near the End of Life

Author Affiliations
  • 1Department of Communication, Portland State University, Portland, Oregon
  • 2Department of Radiation Medicine, The Oregon Health & Science University, Portland
  • 3Department of Radiation Oncology, Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor
JAMA Oncol. 2016;2(11):1407-1408. doi:10.1001/jamaoncol.2016.1948

Despite advances in screening and management, more than half a million Americans will die from cancer this year. Observational studies indicate that many of these patients will receive aggressive treatments near the end of life,1,2 raising concerns about deleterious effects on quality of life and costs,3 along with questions about what factors contribute to this unfortunate pattern. Given that patients’ preferences for aggressiveness of care can depend on their understanding of prognosis, a key question is whether physician-patient communication about prognosis is sufficiently robust, given that cancer care near the end of life is a situation that can naturally challenge the capacity of even the most highly skilled clinician. Prior studies have suggested that patients with advanced cancer often inaccurately view the intent of treatment as curative rather than palliative or have inappropriately optimistic prognostic expectations,4,5 but questions remain regarding the extent to which patients truly misunderstand vs knowingly disagree with their physicians regarding prognosis, as well as whether certain subgroups are particularly vulnerable to misunderstandings in this setting.