Table 2.

Practices: End-of-Life Communication Strategies by Oncologists

Theme	Supporting Quotations
Communicating because of physician responsibly	[Communicating about the end of life] is difficult in the sense that it is emotionally trying, but in terms of having the discussion … that has to be done at the time, and I see it helping to prepare and making sure that down the road that they know what to do. It's an educational piece of what we do.
Open and honest communication	Just by being open … trying not to hide things. I do not give timelines to people unless they ask me specifically. I think in terms of dealing with a palliative situation, I try to let them know this is not a curative situation, they will pass away from their cancer. I think throughout it all, it's just being open and honest.
Ongoing, early conversations	I'm pretty honest about expectations and things from the beginning, so it's not like something new … it's not like a bombshell or anything. It's pretty much from the first time you know that something is not curable; I think I'm very honest about telling the patients that.
Communicating about treatment goals	I say, “we're in a situation now where we're going to be able to control your symptoms, hopefully you can have an appetite, not having pain … but this is not something that we can expect to cure and will likely cause your death.”
	They say, “What's the success rate?” and I say to them, “Well what do you mean by success? We have very many measures of success. That doesn't mean we can't treat it, and we have to really talk realistically about our goals for treatment.” I mean these are words that I use every day of my life for my new patients.
Balancing hope and reality	I try let them know this is not a curative situation … on the other side of that, you don't want to take away all hope as well too, until the point where there really isn't much. So … you want them to be realistic but also not completely devastated.
	I think you do have to have good communication skills and you have to have a lot of true empathy and be able to express that well and be supportive. To be able to walk that very fine line of being optimistic and being hopeful, whereas not give people false hope or unrealistic expectations. That's a challenging thing but I think it's important. Some of my patients used to call me Dr. Death because they thought I was perhaps too negative sometimes, and I think that's probably something I've developed. I don't think you do people a favor by letting them think they're going to live forever or so I think I've probably become better in terms of balancing hope and optimism with the difficult reality sometimes.
Taking cues from patients	There's not a specific plan for discussions about death and dying. I will talk about whatever you want to talk about, and again, for things you don't want to talk about, that's okay.
	If they tell you that they're not comfortable with the fact that they're dying, then I guess they already know, and I don't think that it's really up to me to give them information that they don't necessarily want to hear.