Communication skills for discussing treatment options when chemotherapy has failed.

Palliative care is defined as care for symptoms throughout the disease trajectory delivered along with disease-modifying therapies, whether the patient has curable or incurable cancer. Patients have unique informational and emotional needs at each point in their disease trajectories. To meet each patient's needs, oncologists can follow a road map presented here for discussing treatment options that include palliative care. Oncologists can learn what patients need cognitively by eliciting perceptions about cancer and its treatment before giving any bad news. Emotional reactions can be anticipated and handled with empathy to reduce patient distress. After patients' emotions have been addressed and they are ready to discuss treatment options, oncologists can establish shared treatment goals. These shared treatment goals may need to be negotiated, including resolving conflicts between perceptions and knowledge. Finally, based on these goals, the oncologist can offer patient-centered recommendations and help establish a treatment plan.