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JAMA Intern Med. 2017 Sep 1;177(9):1361-1366. doi: 10.1001/jamainternmed.2017.2005.

A Research Agenda for Communication Between Health Care Professionals and Patients Living With Serious Illness.

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Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts.
Division of Palliative Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.
Psycho-Oncology Co-Operative Research Group, Centre for Medical Psychology and Evidence-Based Medicine, School of Psychology, University of Sydney, New South Wales, Australia.
School of Nursing, Indiana University, Indianapolis.
Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
Baylor College of Medicine, Houston, Texas.
Department of Communication, Texas A&M University, College Station.
Division of Geriatrics, Department of Medicine, University of California-San Francisco.
San Francisco Veterans Affairs Medical Center, San Francisco, California.
Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
Cancer Control and Population Sciences, Duke Cancer Institute, Duke University, Durham, North Carolina.
Department of Community and Family Medicine, Duke University, Durham, North Carolina.



Poor communication by health care professionals contributes to physical and psychological suffering in patients living with serious illness. Patients may not fully understand their illness, prognosis, and treatment options or may not receive medical care consistent with their goals. Despite considerable research exploring the role of communication in this setting, many questions remain, and a clear agenda for communication research is lacking.


Through a consensus conference and subsequent activities, we reviewed the state of the science, identified key evidence gaps in understanding the impact of communication on patient outcomes, and created an agenda for future research. We considered 7 broad topics: shared decision making, advance care planning, communication training, measuring communication, communication about prognosis, emotion and serious illness communication, and cultural issues. We identified 5 areas in which further research could substantially move the field forward and help enhance patient care: measurement and methodology, including how to determine communication quality; mechanisms of communication, such as identifying the specific clinician behaviors that patients experience as both honest and compassionate, or the role of bias in the clinical encounter; alternative approaches to advance care planning that focus on the quality of serious illness communication and not simply completion of forms; teaching and disseminating communication skills; and approaches, such as economic incentives and other clinician motivators, to change communication behavior.


Our findings highlight the urgent need to improve quality of communication between health care professionals and patients living with serious illness through a broad range of research that covers communication skills, tools, patient education, and models of care.

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