--- title: "Goals of care discussions in advanced cancer. | Sutter Health" description: "Frequency, quality, and content of care conversations were shaped by pt receptivity, stage of illness, clinician attitudes, predispositions to palliative care." url: "https://www.sutterhealth.org/research/publications/goals-of-care-discussions-in-advanced-cancer-1055312861" --- 1. [Home](https://www.sutterhealth.org/) / 2. [Research](https://www.sutterhealth.org/research) / 3. [Research publications](https://www.sutterhealth.org/research/publications) / 4. Goals of care discussions in advanced cancer. # Evolving goals of care discussions as described in interviews with individuals with advanced cancer and oncology and palliative care teams. Dillon EC, Meehan A, Nasrallah C, Lai S, Colocci N, & Luft H. _Am J Hosp Palliat Care. 1049909120969202. doi: 10.1177/1049909120969202. Online ahead of print._ 2020-10-28 ## Abstract Background: Individuals with advanced cancer and their families have negative end-of-life experiences when the care they receive is not aligned with their values and preferences. Objective: To obtain in-depth information on how patients with advanced cancer and the oncology and palliative care (PC) clinicians who care for them discuss goals of care (GoC). Design: The research team conducted in-depth interviews and qualitative data analysis using open coding to identify how perspectives on GoC discussions vary by stage of illness, and experience with PC teams. Setting/subjects: Twenty-five patients and 25 oncology and PC team members in a large multi-specialty group in Northern California. Results: At the time of diagnosis participants described having establishing GoC conversations about understanding the goal of treatment (e.g. to extend life), and prognosis ("How much time do I have?"). Patients whose disease progressed or pain/symptoms increased reported changing GoC conversations about stopping treatment, introducing hospice care, prognostic awareness, quality of life, advance care planning, and end-of-life planning. Participants believed in the fluidity of prognosis and preferences for prognostic communication varied. Patients appreciated how PC teams facilitated changing GoC conversations. Timing was challenging; some patients desired earlier conversations and PC involvement, others wanted to wait until things were "going downhill." Conclusion: Patients and clinical teams acknowledged the complexity and importance of GoC conversations, and that PC teams enhanced conversations. The frequency, quality, and content of GoC conversations were shaped by patient receptivity, stage of illness, clinician attitudes and predispositions toward PC, and early integration of PC. [PubMed abstract](https://pubmed.ncbi.nlm.nih.gov/33111553/) ![Natalia Colocci, M.D., Ph.D.](https://dyn.mktgcdn.com/p/VWRHn-FhVXyOQoH9mE4avetDV2Vu6LSi7TvVK9zi54c/fit=crop,gravity=auto,dpr=2,width=188,height=250,quality=100) Natalia Colocci, M.D., Ph.D. Principal investigator [View profile](https://www.sutterhealth.org/research/investigators/natalia-colocci-md-phd-1049680997) ## Research topics - [All Cancer](https://www.sutterhealth.org/research-search-results?query=%22%5C%22All+Cancer%5C%22%22) - [Disease Management](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Disease+Management%5C%22%22) - [Health Services](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Health+Services%5C%22%22) ## Related publications [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) - Publication ### [In absentia: an exploratory study of how patients are considered in multidisciplinary cancer team meetings.](https://www.sutterhealth.org/research/publications/pt-consideration-multidisciplin-cancer-team-mtgs-1055312430) Hahlweg P, Hoffmann J, Härter M, Frosch DL, Elwyn G, Scholl I. PLoS One. 10(10):e0139921. doi: 10.1371/journal.pone.0139921. eCollection 2015. 2015 Oct 06 - Publication ### [The importance of integrating narrative into health care decision making.](https://www.sutterhealth.org/research/publications/integrate-narrative-in-healthcare-decision-making-1055312429) Dohan D, Garrett SB, Rendle KA, Halley M, Abramson C. Health Aff (Millwood). 35(4):720-5. doi: 10.1377/hlthaff.2015.1373. 2016 Apr 01 - Publication ### [The Healthcare Systems Research Network (HCSRN) as an environment for dissemination and implementation research: a case study of developing a multi-site research study in precision medicine.](https://www.sutterhealth.org/research/publications/hcsrn-as-environment-for-implementation-research-1055312447) Rahm AK, Ladd I, Burnett-Hartman AN, Epstein MM, Lowery JT, Lu CY, Pawloski PA, Sharaf RN, Liang SY, Hunter JE. EGEMS (Wash DC). 7(1):16. doi: 10.5334/egems.283. 2019 Apr 12 - Publication ### [Redefining risk and benefit: understanding the decision to undergo contralateral prophylactic mastectomy.](https://www.sutterhealth.org/research/publications/decsion-for-contralateral-prophylactic-mastectomy-1055312294) Rendle KA, Halley MC, May SG, Frosch DL. Qual Health Res. 25(9):1251-9. doi: 10.1177/1049732314557085. Epub 2014 Nov 4. 2015 Sep 01 - Publication ### [Mapping the decision-making process for adjuvant endocrine therapy for breast cancer: the role of decisional resolve.](https://www.sutterhealth.org/research/publications/decision-making-adjuvant-endocr-tx-breast-ca-1055312417) Beryl LL, Rendle KA, Halley MC, Gillespie KA, May SG, Glover J, Yu P, Chattopadhyay R, Frosch DL. Med Decis Making. pii: 0272989X16640488. \[Epub ahead of print\] 2016 Apr 06 [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) ```json {"@context":"https://schema.org","@type":"MedicalOrganization","name":"Sutter Health","@id":"https://www.sutterhealth.org/#medicalorganization","url":"https://www.sutterhealth.org","logo":"https://www.sutterhealth.org/static/images/sutter-health-logo.svg","address":{"@type":"PostalAddress","streetAddress":"2200 River Plaza Drive","addressLocality":"Sacramento","addressRegion":"CA","postalCode":"95833","addressCountry":"US"},"areaServed":{"@type":"AdministrativeArea","name":"California"},"sameAs":["https://www.facebook.com/SutterHealth","https://www.instagram.com/sutterhealth/","https://x.com/SutterHealth","https://www.youtube.com/sutterhealth","https://www.linkedin.com/company/sutter-health","https://en.wikipedia.org/wiki/Sutter_Health"]} ``` ```json {"@context":"https://schema.org","@type":"BreadcrumbList","@id":"https://www.sutterhealth.org/research/publications/goals-of-care-discussions-in-advanced-cancer-1055312861#breadcrumblist","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https://www.sutterhealth.org/"},{"@type":"ListItem","position":2,"name":"Research","item":"https://www.sutterhealth.org/research"},{"@type":"ListItem","position":3,"name":"Research publications","item":"https://www.sutterhealth.org/research/publications"},{"@type":"ListItem","position":4,"name":"Goals of care discussions in advanced cancer."}]} ``` ```json {"@context":"https://schema.org","@type":"MedicalScholarlyArticle","@id":"https://www.sutterhealth.org/research/publications/goals-of-care-discussions-in-advanced-cancer-1055312861#medicalscholarlyarticle","name":"Evolving goals of care discussions as described in interviews with individuals with advanced cancer and oncology and palliative care teams.","headline":"Goals of care discussions in advanced cancer.","abstract":"Background: Individuals with advanced cancer and their families have negative end-of-life experiences when the care they receive is not aligned with their values and preferences. Objective: To obtain in-depth information on how patients with advanced cancer and the oncology and palliative care (PC) clinicians who care for them discuss goals of care (GoC). Design: The research team conducted in-depth interviews and qualitative data analysis using open coding to identify how perspectives on GoC discussions vary by stage of illness, and experience with PC teams. Setting/subjects: Twenty-five patients and 25 oncology and PC team members in a large multi-specialty group in Northern California. Results: At the time of diagnosis participants described having establishing GoC conversations about understanding the goal of treatment (e.g. to extend life), and prognosis (\"How much time do I have?\"). Patients whose disease progressed or pain/symptoms increased reported changing GoC conversations about stopping treatment, introducing hospice care, prognostic awareness, quality of life, advance care planning, and end-of-life planning. Participants believed in the fluidity of prognosis and preferences for prognostic communication varied. Patients appreciated how PC teams facilitated changing GoC conversations. Timing was challenging; some patients desired earlier conversations and PC involvement, others wanted to wait until things were \"going downhill.\" Conclusion: Patients and clinical teams acknowledged the complexity and importance of GoC conversations, and that PC teams enhanced conversations. The frequency, quality, and content of GoC conversations were shaped by patient receptivity, stage of illness, clinician attitudes and predispositions toward PC, and early integration of PC.","description":"Frequency, quality, and content of care conversations were shaped by pt receptivity, stage of illness, clinician attitudes, predispositions to palliative care.","keywords":["All Cancer","Disease Management","Health Services"],"datePublished":"2020-10-28","url":"https://www.sutterhealth.org/research/publications/goals-of-care-discussions-in-advanced-cancer-1055312861","inLanguage":"en-US","identifier":[{"@type":"PropertyValue","propertyID":"PMID","value":"33111553"},{"@type":"PropertyValue","propertyID":"DOI","value":"10.1177/1049909120969202"}],"sameAs":["https://pubmed.ncbi.nlm.nih.gov/33111553/","https://doi.org/10.1177/1049909120969202"],"isPartOf":{"@type":"Periodical","name":"Am J Hosp Palliat Care"},"author":[{"@type":"Person","name":"Dillon EC"},{"@type":"Person","name":"Meehan A"},{"@type":"Person","name":"Nasrallah C"},{"@type":"Person","name":"Lai S"},{"@type":"Person","@id":"https://www.sutterhealth.org/research/investigators/natalia-colocci-md-phd-1049680997","name":"Colocci N","url":"https://www.sutterhealth.org/research/investigators/natalia-colocci-md-phd-1049680997"},{"@type":"Person","name":"Luft H"}],"about":[{"@type":"DefinedTerm","name":"All Cancer","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22All+Cancer%22%5D%7D%5D&verticalKey=research_publication"},{"@type":"DefinedTerm","name":"Disease Management","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Disease+Management%22%5D%7D%5D&verticalKey=research_publication"},{"@type":"DefinedTerm","name":"Health Services","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Health+Services%22%5D%7D%5D&verticalKey=research_publication"}],"mainEntityOfPage":{"@type":"WebPage","@id":"https://www.sutterhealth.org/research/publications/goals-of-care-discussions-in-advanced-cancer-1055312861","breadcrumb":{"@id":"https://www.sutterhealth.org/research/publications/goals-of-care-discussions-in-advanced-cancer-1055312861#breadcrumblist"}}} ```