Meghan McDarby

Background: Medical aid in dying (MAiD) is a practice that enables eligible individuals with a terminal, life‐limiting illness to end their lives in a self‐directed way. Multidisciplinary care teams play a vital role in facilitating discussions and patient decision making about MAiD in cancer care settings. However, little is known about how multidisciplinary care teams navigate MAiD discussions to provide effective, person‐centered care. Objectives: To identify the communication priorities and processes that cancer care clinicians believe are most critical for multidisciplinary care teams when discussing MAiD with patients who have cancer. Design: Cross‐sectional online survey. Setting/Subjects: Multidisciplinary clinicians who participated in a communication training program supported by the National Cancer Institute ( N = 160) responded to five open‐ended survey questions about communication considerations when working with a hypothetical patient with glioblastoma considering MAiD. Participants were presented with a case scenario and invited to describe how they would communicate with that patient as a member of a multidisciplinary team. A thematic analysis of responses using an iterative, inductive approach was conducted until saturation was reached. Results: Four themes were identified as communication priorities and processes critical for multidisciplinary teams when discussing MAiD with cancer patients: (1) addressing complexity of MAiD in GBM; (2) thorough palliative care assessment; (3) strategies for clinicians and healthcare systems to optimize MAiD discussions; and (4) person‐centered care that de‐stigmatizes MAiD. Conclusions: Findings underscore the distinct complexity of MAiD discussions in oncology and highlight the need for tailored, person‐centered approaches that go beyond standard end‐of‐life communication.

Objectives: Existential concerns are inherent in serious illness and at the end of life, yet communication to address such concerns can be challenging. This study explored multidisciplinary oncology clinicians’ experiences navigating existential communication with patients and families, as well as what makes existential communication meaningful and challenging. Methods: This qualitative study analyzed responses to open-ended survey questions collected from N = 83 participants (multidisciplinary oncology clinicians, including nurses, social workers, and chaplains) who participated in a communication training course. Data were analyzed using thematic analysis. Results: Themes across clinicians’ experiences of existential communication with patients and families included existential questions; guilt/regret; fears about the future; grief; preparing for death; values and goals of care; spiritual concerns; and letting go. Meaningful experiences included bearing witness; providing emotional support and information; easing suffering; learning and growing; and the honor of accompanying patients and families through the end of life. Challenges included discomfort when talking about death; facing denial; being unable to “fix it”; resistance to palliative care among oncology team members, patients, and families; fear of saying the wrong thing; navigating conflicting values; responding to spiritual concerns; barriers to inclusive, high-quality care; and struggling with emotions. Conclusions: Existential communication is a vital yet challenging part of oncology care. Clinicians find deep meaning in this work but face emotional and systemic barriers. Findings highlight the need for training, reflection, and institutional support to help clinicians engage in existential communication with patients and families near the end of life.

Objectives: Prognostic discussions are critical in the care of patients with advanced lymphoma, given the disease’s complexity, rapidly evolving treatments, and shifting potential for cure. However, previous research has paid limited attention to how these discussions unfold from both patient and clinician perspectives, particularly in the context of early conversations. The current study sought to identify key experiences that inform improvements in clinician communication and patient understanding of prognosis for patients with advanced lymphoma. Methods: We conducted a qualitative study from July 2023 to June 2024 with 19 patients diagnosed with advanced lymphoma and 3 oncologists. Semi-structured interview transcripts were analyzed using thematic content analysis, and emergent themes were identified through consensus among a trained coding team. Results: Two primary themes emerged. First, patients recalled early prognostic conversations as highly focused on curative intent. Second, oncologists cited incomplete diagnostic data and concerns about overwhelming patients as reasons for limiting early discussions, often delaying deeper prognostic conversations. Clinicians reported tension between maintaining patient hope and providing comprehensive information about disease trajectory and treatment uncertainty. Significance of Results: Findings highlight a need for communication strategies that balance hope with realism in early prognostic discussions for patients with advanced lymphoma. Oncologists may benefit from structured, evidence-based guidance to manage information delivery over time, particularly in the face of diagnostic ambiguity. Future research should prioritize inclusive sampling and explore timing and content of ongoing prognostic discussions to better support informed decision-making and goal-concordant care.

Background: High quality communication between individuals with cancer and their clinicians is a cornerstone of patient‐centered oncology practice. Many communication skills training interventions have been evaluated to support either oncology clinicians or patients. However, there is little information regarding the scope and efficacy of combined communication interventions in oncology, or communication interventions targeting both patients and clinicians.Aims: To systematically examine randomized controlled trials of combined communication interventions in oncology settings.Methods: Four databases (Pubmed, Embase, PsycINFO, and Cochrane Central Register of Controlled Trials) were searched using strategies developed by an expert librarian. All years were searched through May 2024. We followed PRISMA guidelines for reporting and used the Risk of Bias 2.0 assessment tool.Results: The search yielded 3983 records. We assessed 52 full text articles, 13 of which were eligible (8 describing cluster randomized controlled trials, 5 describing individual randomized controlled trials). Results indicate that combined communication interventions may increase patient‐centered communication in oncology settings but may be less effective in improving patient care and related outcomes.Conclusions: Combined communication interventions in oncology settings and the outcomes measured to evaluate them are heterogeneous. This makes it difficult to determine the efficacy of combined communication interventions, the mechanisms by which these interventions improve patient‐clinician communication as well as patient care and related outcomes, and which outcomes are most likely to be improved. Future work should clarify key targets of change for combined communication interventions and outcomes expected to be associated with patient‐focused and clinician‐focused intervention components.

Background: LGBTQ+ persons with cancer and their families consistently face discriminatory care. In addition, clinicians report inadequate population-specific knowledge and communication skills to effectively promote LGBTQ+ inclusion. To fill this gap, we designed a communication skills training based on extant literature; multidisciplinary perspectives; and patient, family, and clinician expert engagement. Methods: Training content comprised didactic information, including exemplar videos of communication strategies, and experiential learning roleplay opportunities with standardized patient and family member actors. Two training sessions were conducted virtually with invited multidisciplinary clinicians using convenience sampling. Each training was followed by a one-hour, semi-structured focus group to solicit feedback on participants’ experiences and recommendations for improvement. Focus group transcripts were thematically analyzed using a constant comparative approach. Results: Two major themes were identified: key takeaways from the training and recommendations for improvement. Participants reported favorable learning experiences and believed the training would have a positive influence on future clinical interactions. We synthesized recommendations into five discrete pieces of feedback related to (1) the advanced level of training material; (2) diversity throughout the training; (3) complexity of family dynamics; and (4) recovery from communication mistakes; and (5) additional topics for future training. Based on feedback, corresponding changes for each item and a refined communication skills blueprint are provided. Conclusions: Our innovative training on inclusive cancer care for LGBTQ+ patients’ families will provide both knowledge-based and experiential learning opportunities to advance clinicians’ confidence in communicating empathically with members of diverse sexual orientation and gender identities. The training is poised for feasibility and efficacy testing.

Background: Patients with cancer use the internet to inform medical decision making. Objective: To examine the content of ChatGPT responses to a hypothetical patient question about decision making in advanced cancer. Design: We developed a medical advice-seeking vignette in English about a patient with metastatic melanoma. When inputting this vignette, we varied five characteristics (patient age, race, ethnicity, insurance status, and preexisting recommendation of hospice/the opinion of an adult daughter regarding the recommendation). ChatGPT responses (N = 96) were coded for mentions of: hospice care, palliative care, financial implications of treatment, second opinions, clinical trials, discussing the decision with loved ones, and discussing the decision with care providers. We conducted additional analyses to understand how ChatGPT described hospice and referenced the adult daughter. Data were analyzed using descriptive statistics and chi-square analysis. Results: Responses more frequently mentioned clinical trials for vignettes describing 45-year-old patients compared with 65- and 85-year-old patients. When vignettes mentioned a preexisting recommendation for hospice, responses more frequently mentioned seeking a second opinion and hospice care. ChatGPT's descriptions of hospice focused primarily on its ability to provide comfort and support. When vignettes referenced the daughter's opinion on the hospice recommendation, approximately one third of responses also referenced this, stating the importance of talking to her about treatment preferences and values. Conclusion: ChatGPT responses to questions about advanced cancer decision making can be heterogeneous based on demographic and clinical characteristics. Findings underscore the possible impact of this heterogeneity on treatment decision making in patients with cancer.

Background: Technology-enhanced mental health platforms may serve as a pathway to accessible and scalable mental health care; specifically, those that leverage stepped care models have the potential to address many barriers to patient care, including low mental health literacy, mental health provider shortages, perceived acceptability of care, and equitable access to evidence-based treatment. Driving meaningful engagement in care through these platforms remains a challenge. Objective: This study aimed to examine predictors of engagement in self-directed digital mental health services offered as part of an employer-based mental health benefit that uses a technology-enabled care platform. Methods: Using a prospective, longitudinal design, we examined usage data from employees who had access to an employer-sponsored mental health care benefit. Participants had access to a digital library of mental health resources, which they could use at any time, including daily exercises, interactive programs, podcasts, and mindfulness exercises. Coaching and teletherapy were also available to. The outcome was engagement with the self-directed digital mental health resources, measured by the number of interactions. Poisson regression models included sociodemographic characteristics, patient activation, mental health literacy, well-being, PHQ-9 and GAD-7 scores at baseline, primary concern for engaging in treatment, and the use of coaching or teletherapy sessions. Results: In total 950 individuals enrolled in the study, with 38% using any self-directed digital mental health resources. Approximately 44% of the sample did not use the app during the study period. Those using both self-directed digital and 1:1 modalities made up about one-quarter of the sample (235/950, 24.7%). Those using only coaching or therapy (170/950, 17.9%) and those using only self-directed digital mental health resources (126/950, 13.3%) make up the rest. At baseline, these groups statistically significantly differed on age, PHQ-9, GAD-7, MHLS, and primary concern. Receipt of coaching and teletherapy was associated with the number of self-directed digital mental health resources interactions in adjusted Poisson regression modeling. Use of any coach visit was associated with 82% (rate ratio [RR] 1.82, 95% CI 1.63-2.03) more self-directed digital mental health resource interactions while use of any teletherapy session was associated with 80% (RR 1.80, 95% CI 1.55-2.07) more digital mental health resources interactions (both P<.001). Each additional year of age was associated with increased digital mental health resources interactions (RR 1.04, 95% CI (1.03-1.05), and women had 23% more self-directed digital resources interactions than men (RR 1.23, 95% CI 1.09-1.39). Conclusions: Our key finding was that the use of coaching or teletherapy was associated with increased self-directed digital mental health resource use. Higher self-directed digital resource engagement among those receiving coaching or therapy may be a result of provider encouragement. On the other hand, when a participant engages with 1 modality in the platform, they may be more likely to begin engaging with others, becoming “super users” of all resources.

Purpose To understand multidisciplinary healthcare clinicians’ meaningful and challenging experiences providing spiritual care to patients with cancer and their care partners. Methods Multidisciplinary clinicians who participated in a communication training program supported by the National Cancer Institute or a palliative care training for nurses (N = 257) responded to two, open-ended questions about meaningful and challenging experiences of providing spiritual care. A thematic analysis of responses using an iterative, inductive approach was conducted until saturation was reached. Results Participants from nursing (68%), social work (22%), and chaplaincy (10%) responded to open-ended survey questions. Three themes related to meaningful experiences of providing spiritual care emerged: building authentic interpersonal connection with patients and care partners; creating intentional space for patients and care partners to inform spiritual care; and actively supporting patients and care partners in their processes with spirituality. Three themes related to challenging experiences of providing spiritual care emerged: contextual factors and clinical circumstances complicate provision of spiritual care; facing barriers to providing high-quality, patient-centered care; and navigating ethical and logistical issues that affect spiritual and other care. Conclusion Clinicians derive meaning from a range of experiences throughout their provision of spiritual care to patients with cancer. However, they also face many challenges in delivering person-centered spiritual care in cancer settings, with some challenges reflecting significant gaps in spiritual care knowledge and training. Findings can guide future training and educational endeavors for multidisciplinary clinicians in the domain of spiritual care.

Background: Spiritual care is a core component of high-quality palliative care, yet gaps exist in spiritual care provision. Understanding clinicians’ levels of confidence around spiritual care and their perceptions of necessary knowledge/skills to enhance their ability to provide spiritual care is foundational for improving delivery of spiritual care in practice. Objectives: To understand confidence levels with providing spiritual care and perceived needs in relation to the provision of spiritual care among palliative clinicians (nurses, social workers, chaplains). Design: N = 260 clinicians participating in interprofessional communication and end-of-life care training programs completed a structured survey. Measurements: Clinicians responded to 42 closed-ended questions assessing their confidence in engaging in spiritual care across 6 dimensions, and one open-ended question: “What areas of knowledge or skill would best help to improve your ability to provide spiritual care across diverse populations?” Results: Findings reveal varied levels of confidence with spiritual care across dimensions. Chaplains reported the highest levels of confidence compared with nurses and social workers. Key areas of knowledge/skills to improve spiritual care provision were: (1) Training and support for clinicians in spiritual care; (2) Strategies for providing spiritual care to patients from diverse cultural and/or religious backgrounds; (3) Better understanding of specific populations and contexts that may affect spiritual care provision; and (4) Clinicians’ personal growth & practices to improve spiritual care. Conclusions: Additional support with spiritual care provision is needed, especially among spiritual care generalists. A focus on culturally attuned care is needed, honoring unique patient contexts and centering patient and family priorities.