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4. Communication and

Decision Making

Busy oncologists It would seem obvious that realistic goals and expectations of treatment, specifics about the
do not always have potential harms and benefits of cancer therapies, and timely feedback regarding scans and
the time, skills, or other tests to ascertain current disease status would all be essential components of informed
inclination to offer decision making for MBC patients. Nevertheless, research indicates that patients are often
details in a form that
patients or family not well informed in any of these areas. Many MBC patients persist in believing a cure is likely,
members can easily when it is not. According to 1 study [76] , two thirds of patients with metastatic cancers were not
grasp, especially informed of the likely impact of a given treatment on their quality of life, and nearly one third
when treatment were unaware of the uncertainty around the described benefit.
choices are unclear
and the prognosis One problem with patient–clinician communication is that, although almost all patients say
may be poor. they wish to receive all possible information around their diagnosis, good or bad, not all truly
wish to know the details [77] . The available research strongly suggests that patients are less
anxious and depressed when their role in making treatment decisions is congruent with their
wishes, suggesting that communication of at least patients’ desires is critical.

MBC patients Busy oncologists do not always have the time, skills, or inclination to offer details in a form
strongly desire that patients or family members can easily grasp, especially when treatment choices are
better unclear and the prognosis may be poor. According to one review, “time constraints in busy
communication clinics, and physicians’ belief that they know the amount and kind of information that is best
with their health for their patients to receive, may contribute to consultations that are physician-directed and
care providers. physician-dominated, leaving patients with unmet communication needs and feelings of
dissatisfaction” [78] . Some research suggests that even when communication is clear, patients
and families may overestimate the likely prognosis and benefits from treatments, which may in
turn interfere with good decision making. This is especially likely to occur toward the end of life,
when an approach that emphasizes palliative care may enhance quality of life and even extend
survival.

A recent, large survey of MBC patients [61] demonstrates the magnitude of the problem, even
in an educated, insured, and advantaged population. The survey found that nearly all patients
received information about their type of cancer but two thirds did not receive any guidance or
tools to assist in decision making. As a consequence, nearly half of those who didn’t write down
their questions before consultation with their physician felt unprepared to make treatment
68 decisions.