Most clinicians do not receive detailed and specific training in how to communicate effectively with patients, nor the complexities and differences between advance directives and POLST forms. Critical medical decisions are often made without patients and families fully understanding the medical facts and without the medical team fully appreciating a patient’s goals and values. Shared decision making can address this gap leading to prognostic concordance. Prognostic Concordance is essential in allowing patients to make decisions based on their values. This concordance allows them to make decisions based on a reasonable prognostic expectation that is agreed upon by the patient and the clinician. 

Communication is also central to the clinician-patient relationship. There are different communication challenges at all phases of the cancer trajectory.  These discussions are typically emotionally charged and overwhelming and require practitioners to develop trust with the patient, identify and respond to patients’ emotions, and sort out when their own emotions interfere with effective communication.