Cancer communication near the end of life has a growing evidence base, and requires clinicians to draw on a distinct set of communication skills. The recent NCI monograph on Patient-Centered Communication in Cancer Care identified six functions of patient-clinician communication: exchanging information, making decisions, fostering healing relationships, enabling patient self-management, managing uncertainty, and responding to emotions.1
While these communication functions shape communication for all patients with cancer, special skills are required for the subset of patients with advanced and incurable cancer who must face death more squarely.2
These patients, with advanced and incurable cancers, are dealing with the emotional impact of a life-limiting illness, treatment decisions that are complex and frequently involve consideration of clinical trials, and the challenges of sustaining hope while also having realistic goals. The clinicians must establish a therapeutic relationship based on trust and mutual respect with patients who often access a great deal of medical information, come from culturally diverse backgrounds, have varying levels of social support, and confront the existential and spiritual aspects of dying, all while trying to access complicated health care systems.3, 4
Because new therapeutic technologies enable these patients to live longer with cancer than ever before, the communication challenges faced by oncology clinicians have become ever more complex, involving uncertainty, hope, and widely available anecdotes of patients who ‘beat the odds’ available on the internet and in books.
In this review, we sought to provide a guide to important evidence and best practices about communication for patients with advanced cancer who face life-limiting illness. Because the state of the science has produced few controlled trials, this narrative review also includes relevant observational, survey, and qualitative studies. We have framed the data from the point of view of oncology clinicians who often have relationships with patients that span the trajectory of the illness. Thus we have divided the review into sections relevant to practicing clinicians: Core communication skills; Communication at diagnosis; Discussing prognosis; Decision-making about palliative anticancer therapy and Phase 1 trials; Advance care planning, Transitions to palliative care; and Preparing patients and families for dying and death.