| Key recommendations |
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| 1.1. Before each conversation, clinicians should review the patient's medical information, establish goals for the conversation, and anticipate the needs and responses of the patient and family. |
| 1.2. At the beginning of conversations with patients, clinicians should explore the patient's understanding of their disease and collaboratively set an agenda with the patient after inquiring what the patient and family wish to address and explaining what the clinician wishes to address. |
| 1.3. During patient visits, clinicians should engage in behaviors that actively foster trust, confidence in the clinician, and collaboration. |
| 1.4. Clinicians should provide information that is timely and oriented to the patient's concerns and preferences for information. After providing information, clinicians should check for patient understanding and document important discussions in the medical record. |
| 1.5. When patients display emotion through verbal or nonverbal behavior, clinicians should respond empathically. |
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| 2.1. Clinicians should provide diagnostic and prognostic information that is tailored to the patient's needs and that provides hope and reassurance without misleading the patient. |
| 2.2. Clinicians should reassess a patient's goals, priorities, and desire for information whenever a significant change in the patient's care is being considered. |
| 2.3. Clinicians should provide information in simple and direct terms. |
| 2.4. When providing serious news, clinicians should take additional steps to address the needs and responses of patients. |
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| 3.1. Before discussing specific treatment options with the patient, clinicians should clarify the goals of treatment (cure versus prolongation of survival versus improved quality of life) so that the patient understands likely outcomes and can relate the goals of treatment to their goals of care. |
| 3.2. When reviewing treatment options with patients, clinicians should provide information about the potential benefits and burdens of any treatment (proportionality) and check the patient's understanding of these benefits and burdens. |
| 3.3 Clinicians should discuss treatment options in a way that preserves patient hope, promotes autonomy, and facilitates understanding. |
| 3.4. Clinicians should make patients aware of all treatment options, including clinical trials and a sole focus on palliative care. When appropriate, clinicians should discuss the option of initiating palliative care simultaneously with other treatment modalities. If clinical trials are available, clinicians should start treatment discussions with standard treatments available off trial and then move to a discussion of applicable clinical trials if the patient is interested. |
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| 4.1. Clinicians should use an organized framework to guide the bidirectional communication about end-of-life care with patients and families. |
| 4.2. Clinicians should initiate conversations about patients' end-of-life preferences early in the course of incurable illness and readdress this topic periodically based on clinical events or patient preferences. |
| 4.3. Clinicians should explore how a patient's culture, religion, or spiritual belief system affects their end-of-life decision-making or care preferences. |
| 4.4. Clinicians should recognize and respond empathically to grief and loss among patients, families, and themselves. Clinicians should refer patients and families to psychosocial team members (eg, social workers, counselors, psychologists, psychiatrists, and clergy) when appropriate. |
| 4.5. Clinicians should identify and suggest local resources to provide robust support to patients, families, and loved ones transitioning to end-of-life care. |
