Patients rate physician communication about lung cancer.

High-quality lung cancer care includes effective physician-patient communication about the disease and treatment, patient needs and preferences, and goals of care.1 To inform rational decision-making about therapy and adequate planning for expected outcomes, patients need and generally want to know about the extent of their disease and the chances that it will be cured.2 Discussion of symptoms and other concerns that may arise from the illness also helps to optimize the patient’s quality of life at any stage of lung cancer. In addition, whether the prognosis is favorable, poor, or uncertain, the physician should elicit each patient’s values and preferences to offer a concordant plan of care. Open, clear, and compassionate communication by clinicians with cancer patients and their families promotes favorable outcomes, including satisfaction with care, adherence to treatment, and physical and psychological well being.3–5 Despite physicians’ concerns that addressing issues related to prognosis and end-of-life care preferences may result in harm to patients or families, research continues to demonstrate the benefits of such discussions.6,7 Early introduction of palliative care for patients with lung cancer, including discussion of goals of care and assistance with decision-making, is associated with significant improvements in quality of life and mood and even with longer survival (evaluated as a secondary endpoint) despite less aggressive treatment at the end of life.8 Thus, communication should be optimized throughout the trajectory of lung cancer.9 Previous studies have documented deficiencies in communication about end-of-life care between physicians and patients with advanced lung cancer.10,11 For example, of over 1500 patients with stage IV lung cancer in the national Cancer Care Outcomes Research and Surveillance (CanCORS) study, barely 50% reported discussing hospice with a care provider, yet more than 70% of those patients died within 6 months of the study interview.12 A survey of more than 4000 physicians caring for Can-CORS patients indicated that, despite national guidelines recommending that they discuss prognosis, resuscitation status, hospice, and preferred site of death with patients expected to die within a year, the majority of physicians would not initiate such a discussion even if death were expected in ≤6 months. Instead, they would defer discussions until the patient became symptomatic or failed non-palliative treatment, and they might never have these discussions unless initiated by the patient or family.13 However, to our knowledge, no previous research has systematically evaluated communication by physicians on a broader range of important topics with patients at all stages of lung cancer. In the current study, we asked patients who had been diagnosed within the previous year with all stages of lung cancer about communication with their physicians on topics related to goals and preferences for treatment and to patients’ physical, emotional, practical, and spiritual needs. We sought the patients’ reports of the extent of communication by their lung cancer physicians while also eliciting information about characteristics of the patient, the illness, and its treatment that may influence this communication.