and are not the consensus views of the workshop participants or members of the National Cancer Policy Forum.
The workshop included an overview of patient-centered care and cancer treatment planning, as well as sessions on shared decision making, communication in the cancer care setting, and patient experiences with cancer treatment. Best practices, models of treatment planning, and tools to facilitate their use were also discussed, as well as policy changes that may promote patient-centeredness by enhancing patients’ understanding of and commitment to the goals of treatment through a shared decision-making process with their healthcare team from the moment of diagnosis onward. While previous Institute of Medicine (IOM) work has focused on the challenges of cancer care planning for individuals who have completed their treatment (sometimes referred to as follow-up or survivorship care planning), this workshop focused on treatment planning for patients with cancer at the time of diagnosis.
Patient-centered care has been defined as “providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions” (IOM, 2001). A primary goal of patient-centered treatment planning is to engage patients and their families in meaningful and thorough interactions with their healthcare providers to develop an accurate, well-conceived treatment plan, using all available medical information appropriately while also considering the medical, social, and cultural needs and desires of the patient and family. A treatment plan may entail a prognostic and therapeutic plan at the time of initial diagnosis, which can be updated with changes during the course of treatment, as well as a prognostic and palliative care plan near the end of life.
Participants at the workshop identified numerous obstacles to achieving patient-centered care planning in practice, including variable and often suboptimal communication between the patient and healthcare provider that may not be culturally or personally appropriate, and information overload for the patient and family, without appropriate written documentation of treatment plans, options, and expectations that the patient and family might refer to after a visit. Many participants also lamented the frequent lack of involvement of primary care physicians and provider teams who might know patient and family better. Numerous factors that might contribute to that lack of involvement were noted, including poor coordination of care or inappropriate exclusion by the oncology team, the inability of primary care physicians to devote the time needed to keep up with myriad complex and rapidly changing cancer treatment regimens, and the lack of