Discussing Prognosis, Preferences, and End-of-Life Care in Advanced Cancer: We Need to Speak
Mené aux Etats-Unis auprès de 278 patients atteints d'un cancer de stade avancé (âge moyen : 62,3 ans) et auprès de 91 médecins, cet essai randomisé analyse l'efficacité d'une intervention destinée à améliorer la qualité de la communication, relative à la gravité de la maladie, entre le médecin et son patient
Conversations about prognosis, priorities, and end-of-life care are stressful, difficult, and vitally important for those affected by advanced cancer.1 These conversations typically occur in the last month of life, in acute care settings, and with physicians outside the patient’s previous health care team.2 Poor communication about these issues is associated with greater suffering and exposure to unpleasant, futile treatments.3 Peak professional organizations and consensus groups recommend making these conversations part of routine oncological care. The Serious Illness Care Program (SICP) was developed to help oncologists improve the frequency, timeliness, quality, and documentation of discussions about these difficult issues.6 The SICP is a complex intervention that includes training, coaching, and prompts for oncologists; information for patients and their families/caregivers; tools for identifying suitable patients and prompting conversations with them; and a mechanism for documenting these discussions in the patient’s electronic medical record (EMR). Developing, implementing, and testing such a complex intervention is a major undertaking.
Much can be learned from the 2 reports of an elegant, rigorous, and innovative clinical trial6 of the SICP reported in the current issues of JAMA Oncology7 and JAMA Internal Medicine.8 The article in JAMA Oncology reports the effects of the SICP on process outcomes—the frequency, timing, quality, and documentation of conversations about serious illness.7 The article in JAMA Internal Medicine reports the effects of the SICP on patient outcomes—care concordant with goals, peacefulness, therapeutic alliance, and psychological symptoms
JAMA Oncology , éditorial en libre accès, 2018