Communications with Patients and Families
Many of us can use ongoing training in communicating with patients and families. Here, you’ll find techniques to address a broad range of topics that you have likely encountered including how to break bad news, how to break really bad news, and how to assess what is really going on when patients or families’ questions seem difficult to understand or untangle. You’ll see how to recognize existential suffering and your own moral distress, which can happen when, for example, you are asked to help patients end their lives.
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Introduction
Advance Care Planning
Large language models to identify advance care planning in patients with advanced cancer.
J Pain Symptom Manage 2025;69:243-250
“You are not alone”: the allure and limitations of artificial intelligence in serious illness communication.
J Palliat Med 2024;27:7-9
“Rehabbed to Death” in oncology: where do we go from here.
JCO Oncol Pract 2024;21:107-109 (editorial in response to Singh 2025 paper)
Conversational agents in palliative care: potential benefits, risks, and next steps.
J Palliat Med 2024;27:296-300
Respect for the patient-oncologist relationship may limit serious illness communication by acute and postacute care clinicians after discharge to a skilled nursing facility.
JCO Oncol Pract 2024;21:163-169 (see also Lage editorial)
Bolstering advance care planning measurement using natural language processing.
J Palliat Med 2024;447-450
Communication Pearls
Mastering Communication with Seriously Ill Patients: Balancing Honesty with Empathy and Hope
New York: Cambridge University Press, 2nd ed., April 25, 2024.
How to Break Bad News: A Guide for Health Care Professionals
Baltimore : Johns Hopkins University Press. 1992
Compassion: The Essence of Palliative and End-of-Life Care
New York: Oxford University Press. 2016
Difficult Conversations: How to Discuss What Matters Most
New York, NY: Penguin Books; Updated Edition 2023
Approaching Difficult Communication Tasks in Oncology
CA Cancer J Clin. 2005 May-Jun; 55(3):164-77. DOI: 10.3322 canjclin.55.3.164. PMID: 15890639
Palliative Care Skills and New Resources for Oncology Practices: Meeting the Palliative Care Needs of Patients With Cancer and Their Families
American Society of Clinical Oncology Educational Book. American Society of Clinical Oncology. Annual Meeting 2020 Mar; 40:1-9. PMID: 32213085
SPIKES: A Six-step Protocol for Delivering Bad News: Application to the Patient with Cancer
Oncologist. 2000; 5(4):302-11. DOI: 10.1634. theoncologist.5-4-302. PMID: 10964998
REMAP: A Framework for Goals of Care Conversations
J Oncol Pract. 2017;13:e844-e850
Effect of chair placement on physicians’ behavior and patients’ satisfaction: randomized deception trial.
BMJ2023;383:e076309.
Comments from Dr. Abrahm:
“… 1.8 chairs need to be placed for a [hospitalist] physician to sit.” With a chair present, 38 of 60 physicians sat versus 5 of 65 when there was no chair. When physicians sat, they spent no more time in the room, but patient satisfaction was greater (p=0.02). The absolute difference was small (88.0% (SD 8.9%) vs 84.1% (SD 9.1%).
Making every minute matter: practical strategies to enhance high-quality, time-efficient hospice and palliative care visits.
J Palliat Med 2024;27:1578-1582.
Debriefing challenging clinical encounters: the pause framework #474.
J Palliat Med 2024;27:421-422
Comments from Dr. Abrahm:
P= prepare; A =Analyze; U = Understand; S = Sentiment; E = Educate
Existential Suffering
The Physician’s Role in Responding to Existential Suffering: What Does It Mean to Comfort Always?
J Palliat Care 2020;35:8-12.
Top ten tips palliative care clinicians should know about attending to the existential experience.
J Pain Symptom Manage 2024;27:1379-1388.
Helping Parents with Cancer Communicate with Their Children
MOLST/POLST ACP Forms
Sort by state:
MOLST Form
The MOLST form is a set of medical orders for patients with advanced illness who might die within 1-2 years; require long-term care services; or wish to avoid and/or receive specific life-sustaining treatments now. Best practice is to offer MOLST. Completion of MOLST is voluntary. The physician, nurse practitioner (NP) or physician assistant (PA), beginning June 17, 2020, reviews the patient’s current health status, prognosis, the patient’s goals for care, risks and benefits of each life-sustaining treatment with the patient if they have capacity, or the health care agent or surrogate if the patient lacks capacity. All ethical and legal requirements must be followed, including special procedures when a patient has an intellectual or developmental disability and lacks capacity. If the patient is unable to make medical decisions, the medical orders should reflect patient wishes, as best understood by the health care agent or surrogate and based on the patient’s values, beliefs and goals.
POLST Form
A POLST form is generally only appropriate for people who are in the final year of life, or suffering from an advanced stage terminal illness or an illness from which they are not expected to recover. It is complementary to an Advance Directive. (To find your state’s advance directive form, use our resource State-by-State Advance Directive Forms.)
Moral Distress
Compassion: The Essence of Palliative and End-of-Life Care
New York: Oxford University Press. 2016
Serious Illness Conversations
SIC Guide
Mastering Serious Illness Communication: An Interview with Dr. James Tulsky
March 2026
VitalTalk.org
Learn to communicate effectively with seriously ill patients.
Miscellaneous
Regret in clinical trial participation among cancer patients.
J Palliat Med 2025;28:185-192
Prognostic understanding among patients with advanced cancer recently referred to an enhanced supportive care service: results from the cross-sectional ProgESC study.
Support Care Cancer 2025;33:388
From Comfort to Cure in Cancer Care: Use Palliative Care From the Start
Cure Magazine, July 2024
Bringing Palliative Care to Every Patient with Cancer: A Conversation with Janet L. Abrahm, MD, FACP, FAAHPM, FASCO
Reprinted with permission from The ASCO Post.
March 2025
Multidisciplinary oncology clinicians’ experiences delivering spiritual care to patients with cancer and their care partners.
Support Care Cancer 2024:32:586
Association of limited health literacy with frailty, health-related quality of life, and health care utilization among older adults with cancer: the cancer and aging resilience evaluation registry.
JCO Oncol Pract 2025;21:720-728
Prognostic beliefs in patients with cancer receiving outpatient palliative care.
Support Care Cancer 2025;33:377
Redefining Palliative Care and The Role of Supportive Care in Cancer Treatment with Dr. Janet Abrahm
November 17, 2024
Comments from Dr. Abrahm:
Authors in both papers discuss the risks and benefits of “conversational agents”: i.e. chatbots, for patients requiring palliative care services.