Improving Clinician Communication
Dr. Li comes from a family of physicians. His mother was an infectious disease physician, and his father was a neurosurgeon in China. Due to the loss of his grandparents from different types of cancer, Dr. Li knew early on in his medical training that he wanted to specialize in oncology. He focused on gastrointestinal (GI) oncology while training at his hematology-oncology fellowship at Memorial Sloan Kettering in New York City. During his fellowship, Dr. Li noticed that compared to the many treatment options available for breast cancer, GI cancer treatment options were very limited. As a result, he felt that dedicating his research to treating GI cancer would have a more significant impact and address a more dire need. Dr. Li’s mentor, Dr. Arti Hurria, instilled the value of palliative care during his medical training as a GI oncologist. Dr. Li observed that the characteristics of his patients, such as their age, social support, functional status, and daily routine, affect the priorities of their treatment plan.
As an oncologist, Dr. Li initiates difficult conversations by establishing a trusting relationship with his patients. When developing a treatment plan for his patients, he ensures that he fully understands their goals. For example, Dr. Li had a patient who passed away four years after battling liver cancer. After his passing, Dr. Li received a card that contained pictures of all the different life events the patient participated in, such as attending his granddaughter’s graduation, traveling internationally, and celebrating events such as birthdays and weddings. When patients meet their goals, it often uplifts them throughout treatment.
Located in Duarte, California (just outside of Los Angeles), City of Hope focuses on basic and clinical research in cancer. Due to the varying backgrounds of his patients, Dr. Li says it can be challenging at times to help patients understand the difference between hospice and palliative care. He explains that palliative care involves symptom management that can happen anytime during the diagnosis journey. In contrast, hospice takes it one step further and prioritizes comfort over everything else. As a provider, Dr. Li has witnessed different cultural approaches to palliative care. Families with an Asian background tend to avoid talking about the disease outcome and prioritize survival above all other measures. Other cultures might prioritize other things besides survival. As a result, Dr. Li notes that different cultural values may affect the healthcare decisions of patients and their families.
Dr. Li feels that shared decision-making is a concept that healthcare agencies made up. About a century ago, healthcare was very paternalistic. The doctor made a recommendation, and patients had to follow it. Then, the healthcare industry introduced shared decision-making when it shifted toward patient-centered care. Dr. Li believes that patient-centered care is important, but the industry has gone too far.
He explains that providers should not ask patients what they want because no patient or caregiver has the knowledge or experience to confidently choose the best form of care when they initially receive their diagnosis.
He indicates this is unfair to the patient and should not be considered shared decision-making.
Instead, Dr. Li discusses different treatment options, makes a clear-cut recommendation, and provides the reason for this recommendation. He then incorporates the patient's input by asking if his recommendation aligns with their goals.
For physicians to improve at having tough conversations, Dr. Li recommends VitalTalk, a communication skills program for clinicians. Dr. Li emphasizes that knowing how to share an uncertain prognosis is a vital communication skill for healthcare providers. A potential approach involves asking about best-case situations and worst-case situations. So, instead of just discussing the most optimistic outcome, the conversation can cover a range of things that can happen and provide more clarity about what to expect.
