“Shoot from the Hip”: What Patients with Cancer Want from Communication About Serious Illness During COVID-19 (S526)

Abstract

Outcomes1. Describe what patients with cancer and caregivers value in communication about serious illness2. Examine strategies that model these valuesOriginal Research BackgroundWhen asked to share recommendations for providers and health systems to foster high-quality care during COVID-19, patients with cancer and their caregivers recommended providers to “communicate proactively and effectively” about serious illness.Research ObjectiveIn this secondary analysis of participant responses, we aimed to identify patient and caregiver perspectives on what it means to “communicate proactively and effectively” about serious illness.MethodsContent analysis of communication-related output from 15 semistructured interviews of diverse patients with cancer and caregivers of patients with serious illness.ResultsTheme 1: Transparency: Clinicians share the medical rationale for recommendations: “If what's explained to me is that my chance of recovery … is minimal, and I'm just going to increase my suffering, well, then that feels like a chance for acceptance.”Theme 2: Proactivity: Clinicians facilitate conversations about care preferences in advance: “Right now, you guys have this incredible opportunity to have these conversations. To enable—you know, oncologists to have these conversations with their patients while they're as an outpatient, before they get COVID?”Theme 3: Coordination: Clinicians integrate with the interdisciplinary palliative care team to communicate serious news: “I would ask that [what] be done a little bit better is the integration of the social worker with the doctor, especially in the palliative and hospice care. We know that not every doctor has got a good bedside manner… it's hard to tell someone you're going to die.”Theme 4: Respect for autonomy: Patients and caregivers feel empowered by clinicians to make informed decisions: “You're still in control of your decision-making, given the parameters, even though you're not in control of the parameters.”ConclusionPatients with serious illness and caregivers of patients with serious illness value transparent, proactive, and coordinated communication that respects their autonomy.Implications for Research, Policy, or PracticeEfforts to make serious illness communication more patient-centered during COVID-19 will target these areas that align with established patient-centered communication theories.