AMA Journal of Ethics theme editor Renee Mao, a third-year medical student at the George Washington University School of Medicine and Health Sciences, interviewed Dr. Tarris Rosell, PhD, DMin, MDiv, about strategies for incorporating spiritual care into oncology.
Barriers to effective prognosis conversations include knowledge deficits, misconceptions, cultural differences, and lack of motivation. These can be addressed head-on by good communication interventions.
AMA J Ethics. 2018;20(8):E757-765. doi:
10.1001/amajethics.2018.757.
The physician must help patients understand that all options—further testing, surgery, no action—carry risks and benefits. Disclosing the statistical probability of injury and other possible outcomes might help, but it can also hinder the process.
After assessing the reasons for a patient’s unrealistic hopefulness in the face of clear understanding, a clinician may believe that significant harm will come to the patient if he or she does not acknowledge the seriousness of the illness.
One strategy is to determine “triggers” that alert the primary clinician that the patient has a high symptom burden or difficulty coping with the diagnosis, prognosis, or treatment plans and should be offered palliative care services.