Communication in End-Stage Cancer: Review of the Literature and Future Research

Abstract

Concerns have been raised about the quality of life and health care received by cancer patients at the end of life (EOL). Many patients die with pain and other distressing symptoms inadequately controlled, receiving burdensome, aggressive care that worsens quality of life and limits patient exposure to palliative care, such as hospice. Patient–physician communication is likely a very important determinate of EOL care. Discussions of EOL with physicians are associated with an increased likelihood of the following (1) acknowledgment of terminal illness, (2) preferences for comfort care over life extension, and (3) receipt of less intensive, life-prolonging and more palliative EOL care; while this appears to hold for White patients, it is less clear for Black, advanced cancer patients. These results highlight the importance of communication in determining EOL cancer care and suggest that communication disparities may contribute to Black–White differences in EOL care. We review the pertinent literature and discuss areas for future research.

This research was supported in part by the following grants to Dr. Prigerson: MH63892 from the National Institute of Mental Health and CA 106370 from the National Cancer Institute; the Center for Psycho-Oncology and Palliative Care Research, Dana-Farber Cancer Institute; a National Cancer Institute Dana-Farber/Harvard Cancer Center—University of Massachusetts/Boston Partnership (U56CA118641) pilot grant “Racial Disparities at the End of Life”; a Dana-Farber/Harvard Cancer Center (P30CA06516-43) Nodal Award “Study to Test the Trice Advanced Cancer and End of Life Treatment Scale”.