Table 2.

Topics of Communication About Systemic Therapy Discontinuation or Hospice between Patients and Families and Their Palliative Care Clinicians during Visits That Occurred in the Absence of Acute Medical Deterioration

Articulate patient quality-of-life values and goals

Clinician: Is there…any kind of symptom or… harder quality of life that would be a deal breaker for you in terms of treatment?

Patient: The [chemotherapy] wasn't easy, but it wasn't intolerable, and if that's going to work, I'm going to do whatever it takes to make it work. [It's]a gut-level, that if it's working, then I go for it.

Address basic information about hospice

Clinician: Oftentimes there's an aide or a volunteer, chaplain, social work, all coming to the home. Medicines getting delivered… a hospital bed or commode. These things getting delivered to try to help patients and families maximize their time at home.

Explore prognostic understanding

Patient: …The chemo is working so well that the tumor's been shrinking and shrinking. [My oncologist] has given me another six months, or another year, [but]… this is all based on the ‘man upstairs’… I mean there is no remission, there is no cure.

Normalize and ‘test the waters’ for discussing EOL concerns

Clinician: …Generally at the very final stages of a disease, that's called hospice care… and we can talk more over time about what that looks like or if you want information—

Family: Can you explain a little bit now…?

Identify preferences for future EOL care plans, including use of hospice

Clinician: There's the possibility of… having people in your home to care for you that free your family to be less direct in caregiving and preserve the…family role for them.

Patient: Yeah. I have considered that… Those are things we need to settle.

EOL, end-of-life.