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. 

Most clinicians do not receive detailed and specific training on how to communicate effectively with patients, nor the complexities between advance directives and POLST forms. It is imperative that clinicians are given proper training, and the necessary tools to identify the need for and encourage the use of an advanced directive and POLST forms, as well as become aware of the resources that are available at City of Hope to them regarding advanced directive accessibility. A proper training on how utilizing the SPIKES protocol to deliver news, is also beneficial and necessary as such methods will result in better patient outcomes when serious illness conversations are had.