Studying Difficult Conversations

Researchers examine how oncologists, patients and families connect—or don't

They might be among the most critical communications in health care: discussions about treatment options between a physician and a patient with an advanced illness.

An ongoing five-year study led by a Case Western Reserve nurse scientist, however, is revealing more about a known disconnect that can occur between the physician and patient in terms of their respective goals of care, especially at the end of life. One might prefer aggressive treatment, for example, while the other might believe comfort care is the better aim.

The research, funded by a grant of nearly $2.1 million from the National Institute of Nursing Research, focuses on 378 people with stage 4 cancer, their caregivers/families and oncologists. It is expected to be completed next year.

This is the first study to measure the extent of agreement and discord over care goals over time (in this case, 15 months) and to include caregivers, said study leader Sara Douglas, PhD, RN, the Arline H. and Curtis F. Garvin Professor in Nursing Excellence and assistant dean for research at Frances Payne Bolton School of Nursing.

Douglas and her team are asking study participants at University Hospitals Seidman Cancer Center in Cleveland to indicate their goals of care for their treatment plan every three months on a scale, with "survival" and "comfort" care at opposite ends.

The final study will include results and recommendations for how to improve discussions.

"My hope is that it would become easy, feasible and acceptable to ask oncologists or any doctor and patients to answer a single question: 'Regarding your care right now—or the care of your patient—what's most important to you?' " she said. "That would then spark a very real and important conversation."

—Mike Scott