Enhancing proactive life-sustaining treatment preference documentation in advanced cancer care: barriers and...

Despite guidelines, life-sustaining treatment preferences (LSTP) documentation for advanced cancer patients remains limited and reactive to clinical events. As proactive documentation is a core component of early palliative care (EPC), addressing barriers to EPC can in parallel facilitate LSTP documentation. This narrative review examines barriers to both processes and proposes recommendations to overcome them.

Barriers stem from patients, oncologists, and the healthcare system. Patients and oncologists face communication challenges. For patients, knowledge gaps on illness and LSTP documentation, family dynamics prioritizing informal over formal discussions, and limited intercultural considerations, compound these challenges. For oncologists, a curative-focused medical culture reinforces them. In the healthcare system, this culture contributes to deprioritizing LSTP documentation.

Addressing these barriers requires multilevel recommendations. For patients: interventions to enhance illness understanding, foster culturally sensitive oncologist communication, and optimize care organization. For oncologists: integrating communication training and palliative care (PC) knowledge into oncology fellowships while cultivating a supportive medical culture for LSTP documentation through role modeling and intervision. For healthcare systems: LSTP documentation benchmarks, proactive EPC integration through automated reminders, telehealth, standardized medical records, and reimbursement codes. Assessing the implementation and sustainability of these recommendations is crucial to enhancing proactive LSTP documentation in advanced cancer care.