4.5.1 Implications for CME
Continuing education in the area of physician-to-physician communication could use some of the approaches described for patient-physician communication detailed in Practice Performance Gap #3.
Additionally, the American College of Physicians (ACP) has created a toolkit to facilitate more effective communication between primary care and specialty practices. This toolkit provides practical components, such as checklists for information to communicate and templates for filling in pertinent treatment-related data. Also included is a model of care coordination agreement that can facilitate discussions on roles and responsibilities . Tools such as these can lead to more detailed and productive discussions between medical oncologists, geriatricians, and primary care physicians.
4.6 Practice Performance Gap #5: Articulate in what ways the goals of care for geriatric patients are the same and how they may differ from that of younger patients
The physicians participating in our analyses agreed with those interviewed that, regardless of age, the goals of care remain the same for all cancer patients:
- Increase life expectancy if possible
- Prolong remission
- Palliation of symptoms
However, medical oncologists acknowledged being accepting of an older patient’s goals of aggressive or minimal treatment, and understanding patient desire for quality over quantity of life. Discussing end-of-life goals such as these can be difficult, and physicians acknowledge this is an area in need of improvement in their own clinical practices by rating “Communicate with the geriatric patient, family, and caregivers about desired goals of care” as a perceived need. Fully understanding a patient’s goals and treatment expectations allows clinicians to select a treatment regimen that best aligns with these. If the patient opts for treatment, the clinician must provide clear communication and education regarding feasible options and possible outcomes with each. On the other hand, patients who feel they may not have many years left may choose to forego treatment so that their remaining time is of higher quality by avoiding treatment-related toxicities.
4.6.1 Implications for future CME
There is also a strong need for education in the areas of communicating expectations to patients for palliative care and end-of-life discussions, all of which are closely related to Practice Performance Gap #3 regarding effective patient-physician communication, and all of which contribute to selecting the optimal treatment approach for a patient. Studies focusing on communication issues regarding palliative care and the disclosure of prognosis have determined that many physicians are not comfortable discussing prognosis and end- of-life issues, and thus tend to avoid them [15-18]. Interventions and tools for clinicians to navigate these highly complex and difficult conversations are needed.