This post derives from a critical slide I teach during fellow orientation each year.
This framework is for trainees, patients and families, and oncologists.
Here is the smart phrase that goes in each of my first notes.
We discussed the cancer framework in four questions that typically address most patients' and families' concerns and provide a good way to approach cancer diagnosis.
1 What is my cancer? DIAGNOSIS:
2. Where is my cancer? STAGING:
3. What does it mean for me? PROGNOSIS or TREATMENT GOALS:
4. What do we do about it? TREATMENT OPTIONS:
DIAGNOSIS:
STAGING:
TREATMENT GOALS:
TREATMENT OPTIONS:
I use this framework for all my conversation. This helps ground the conversation and conveys information that patients want and need in simple words. More than 95% of questions brought by patients and family at their first visit are answered with this framework.
I typically stop after first or first two questions (diagnosis and staging) and then again after the treatment goals where I discuss whether this cancer is curable or not.
Pausing allows each person to recognize the gravity of the information being provided. Most patients and family (and many times the doctor) want to address their treatment options and bypass understanding prognosis or treatment goal. I highly resist the urge to get to the treatment options.
It is not just pausing, it is using our empathic responses to allow for the information to sink in. After each pause, ensuring that there are no questions is key before moving forward.
Once I get to treatment option, I discuss standard of care as well as clinical trial options, pausing after each option. I cover risk and benefits of each. Whether I talk about the risk and benefits of each of the options or provide all options at once before discussing risk and benefits is a call I make at the time of that discussion.
For those patients who are seeing me in second opinion, I use the same framework and use the information they have learned to put them in the four questions. I highlight when the goal of their treatment changed, if it did.
This framework is derived from experience and backed by the ASCO Guidelines. Of course, there are adaptations to include genomic markers as part of diagnosis description. This framework also helps in shared decision making discussion.
What framework do you use in communicating information with your patients with cancer diagnosis? What about non-cancer patients? Those with other “C” diagnoses like: Congestive Heart Failure? Chronic Obstructive Pulmonary Disease (COPD) or Chronic Kidney Disease (CKD)?
Biren Saraiya MD
—
Reference: Patient-Clinician Communication: American Society of Clinical Oncology Consensus Guideline. Journal of Clinical Oncology Volume 35, Number 31