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Related Concept Videos

Nursing Ethical Principles II01:27

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Ethical principles are essential in guiding nurses to fulfill their responsibilities, focusing on the quality of nursing care and decision-making. These principles, including autonomy, beneficence, non-maleficence, justice, and fidelity, shape the ethical framework within healthcare settings.
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Cancer survival analysis focuses on quantifying and interpreting the time from a key starting point, such as diagnosis or the initiation of treatment, to a specific endpoint, such as remission or death. This analysis provides critical insights into treatment effectiveness and factors that influence patient outcomes, helping to shape clinical decisions and guide prognostic evaluations. A cornerstone of oncology research, survival analysis tackles the challenges of skewed, non-normally...
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Focusing involves centering a conversation on a message's critical elements or concepts. Focusing is valuable if the talk is vague or patients begin to repeat themselves. Sometimes, when patients are asked about their symptoms, they may go off-topic and try to tell their entire life story. Respectfully, the nurse should bring the conversation back into focus.
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Related Experiment Video

Updated: Jun 22, 2025

Competing-Risk Nomogram for Predicting Cancer-Specific Survival in Multiple Primary Colorectal Cancer Patients after Surgery
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Clinician- and Patient-Directed Communication Strategies for Patients With Cancer at High Mortality Risk: A Cluster

Samuel U Takvorian1, Peter Gabriel1, E Paul Wileyto1

  • 1Perelman School of Medicine, University of Pennsylvania, Philadelphia.

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Combining clinician and patient nudges marginally increased serious illness conversations (SICs) in cancer care. This strategy may improve end-of-life care planning by encouraging these vital discussions.

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Area of Science:

  • Oncology
  • Health Services Research
  • Behavioral Economics

Background:

  • Serious illness conversations (SICs) are crucial for aligning cancer care with patient values and goals.
  • Despite their benefits, SICs are infrequently completed for patients with cancer.
  • Behavioral economic strategies (nudges) show potential for increasing SIC completion rates.

Purpose of the Study:

  • To evaluate the independent and combined effects of clinician- and patient-directed nudges on the completion of SICs.
  • To determine if behavioral nudges can improve the frequency of documented serious illness conversations in oncology settings.

Main Methods:

  • A 2x2 factorial cluster randomized trial involving 163 clinicians and 4450 high-risk cancer patients.
  • Interventions included clinician nudges (reminders, peer comparisons) and patient nudges (priming questionnaires).
  • The primary outcome was a documented SIC in the electronic health record within six months of randomization.

Main Results:

  • Overall SIC completion was 11.2% in the active control group.
  • Combined clinician and patient nudges resulted in a marginal increase in SIC completion (14.1%) compared to active control (OR 1.55, P=0.049).
  • Individual clinician or patient nudges did not significantly increase SIC completion rates.

Conclusions:

  • A combined approach using clinician peer comparisons and patient priming questionnaires modestly increased documented serious illness conversations.
  • Integrating clinician- and patient-directed nudges may be a viable strategy to promote SICs in routine cancer care.
  • Further research is needed to optimize nudge strategies for widespread adoption.