An Opportunity to Study Mechanisms of Palliative Care by Integrating into Management of The Treatment of Renal Cancer Carcinoma

Abstract

Achieving patient-centered care requires helping patients understand their illness, eliciting patient values, and developing a collaborative care plan with input from patient and physician. Combining existing models in communication skills and shared decision making provides a road map for accomplishing these tasks in delivering patient-centered care. In this article, we highlight the importance of patient understanding of their prognosis as a key step in delivering patient-centered care. We then review literature suggesting that both patient and patient’s physicians’ emotions play an inhibitory role in accurate formulation and communication of prognosis by physicians and accurate incorporation of this information by patients. We postulate that the finding of benefit of early integration of palliative care (PC) in improving patient-centered outcomes may be addressing these inhibitory factors. Key skills of empathic communication by a PC team that is focused on addressing patient emotions may facilitate better understanding of prognosis and thus improved patient-centered decision leading to improved patient centered outcomes. Finally, we propose advances treatment of renal cell carcinoma makes it an ideal disease that can inform this hypothesis of how integration of PC works. Specifically, we propose that the curability potential in metastatic RCC, amplifies challenges associated with patient prognostic understanding and decision making. Studying which discipline – primary oncology team or palliative care team – can help patients achieve more accurate prognostic understanding leading to more patient centered choices and improved patient-centered care.