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Communicating anticancer treatment cessation and transition to palliative care: The need for a comprehensive and culturally relevant, person‐centered approach

Communication, with its main objective of creating a good and trustful physician-patient relationship, is the cornerstone of comprehensive person-centered care in all medical settings, especially oncology, in which an immense body of literature has been published over the last 30 years. Several studies have demonstrated that a paternalistic approach, in which physicians know best and decide what should be told to and done for a patient with cancer, has been replaced by the delivery of correct information and a shared decision-making approach. However, in advanced phases of cancer, when pursuing aggressive curative treatment is futile, if not harmful, it is extremely difficult and challenging both to communicate the need for the transition to palliative care and to assess the impact of prognostic information on the patient and their family. Data from some studies are currently available on the experience of patients with advanced cancer when receiving information about their incurable state. Patients’ perceptions of their physicians are mainly based on both physicians’ styles of communication (eg, physicians may be perceived as inexperienced messengers; emotionally burdened, rough-and-ready experts; distanced, benevolent, but tactless experts; or empathic) and the words they use. Recommended steps for facilitating the cessation of curative treatment and the transition to palliative treatment and care have been outlined, including preparing patients for the discussion, identifying the information to be provided, responding to the patient’s emotional reaction and family concerns, and cultural and linguistic diversity. In this issue of Cancer, Umezawa and colleagues explore communication preferences regarding ending anticancer treatment and transitioning to palliative care and the variables associated with these preferences among 100 Japanese patients with cancer. Several items investigating what patients would prefer their physicians to say reached almost total endorsement both in the informative and symptom-management area (eg, “I would like my physician to assure that painful symptoms would be controlled” [endorsed by 97.1%]; “I would like my physician to explain the status of the illness and the physical symptoms that would likely occur in the future” [endorsed by 95.1%]) and in the emotional area (eg, “I would like my physician to listen to distress and concerns” [endorsed by 96%]; “I would like my physician to say they will support me continuously in the future” [endorsed by 90.2%]). The analysis of Umezawa and colleagues’ data highlights several important issues, strongly indicating the need for comprehensive and integrated, person-centered care in oncology.