title: Palliative care and advance care planning for patients with advanced malignancies.
abstract: Patients diagnosed with an advanced cancer frequently have a very limited life expectancy and need to understand their prognosis in order to make good choices about care. Advance care planning (ACP) is an important aspect of this care but can be especially difficult to address. Most patients and families prefer direct and honest communication, but they may interpret the information they are given in very different ways. In addition, oncologists strive to communicate honestly and sensitively, but often struggle with the best approach. Finally, standardization of ACP is challenging because patients have highly individualized values, traditions and social and family dynamics that guide their preferences. Palliative Care is a rapidly growing field that specializes in communication and patient-centered approaches to care. Treatment of patients with advanced or metastatic cancer should prioritize early discussions of ACP to ensure high quality end-of-life care. When available, this care should be delivered through careful integration with palliative care specialists.
authors.affiliation: Department of Hematology and Oncology, Hospice and Palliative Medicine Service, Hospital of the University of Pennsylvania, Philadelphia, PA, USA. Anjana.Ranganathan@uphs.upenn.edu.
authors.forename: Anjana
authors.initials: A
authors.lastname: Ranganathan
authors.affiliation: Department of Hematology and Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Orvar
authors.initials: O
authors.lastname: Gunnarsson
authors.affiliation: Hospice and Palliative Medicine Service, Hospital of the University of Pennsylvania, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Casarett
keywords: Cancer; advance care planning (ACP); communication; palliative care