Communication with cancer patients about palliative and end-of-life care

Abstract

Communication with a cancer patient and his/her family takes place in a dynamic way. Steps of communication concern the seriousness of the illness and the chances of cure, the ineffectiveness of treatment, the opportunity to start a palliative care program, and end-of-life decisions. The moment when palliative care should be offered depends on the attitude of the team that is in charge of the patient. In general, palliative care is offered when cancer-directed therapy is no longer effective. Nevertheless, there is an increasing trend to suggest palliative care earlier, at the diagnosis of cancer, not at the end of the treatment, thus encouraging synergy between palliative care providers and oncologists. This attitude can both increase the quality of life of the patient and limit the risks of a discontinuity of clinical management. The decision about the start of palliative care should be based on candid communication between physicians and patients, so as to allow the latter to make well-grounded decisions concerning treatment and the time necessary for each possible intervention to be carried out. Physicians should know the case history and the possibilities offered by palliative care as well as have cross-cultural competence to understand and speak in relation to the culture, expectations, and real needs of the patient and his/her family at each stage of illness.