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Comment & Response
May 2018

The Paradigm of Escalation of Commitment in Treatment Decisions Near the End of Life

Author Affiliations
  • 1Geisel School of Medicine, Dartmouth Hitchcock Medical Center, New Hampshire
JAMA Oncol. 2018;4(5):742. doi:10.1001/jamaoncol.2017.4704

To the Editor Knoops and Bastin1 focus on an important population of patients who have hematological malignant neoplasms with uncertain prognoses and a high chance of suffering from distressing symptoms during the course of their cancer and treatment. Their description of “escalation of commitment” is a fitting paradigm in this population and with this patient-physician dyad. They recommend several strategies to defend against this bias, including clinician self-reflection, discussing risk of treatment failure and alternative approaches even before starting disease modifying therapy, and finally involving a third party such as a palliative care specialist.

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