Expert Commentary

The Impact of US Healthcare Policy on Advance Care Planning Part II

Andrew Epstein, MD

Palliative Medicine
Mount Sinai Medical Center
New York, New York

Recent changes in US healthcare law have raised awareness among oncologists on the importance of advance care planning. The American Society of Clinical Oncology (ASCO) has created educational initiatives on this subject and published a guide on advanced cancer care planning for patients and their families. To deliver better end-of-life care, special communication tools and documents to establish patients’ needs and preferences are available to oncologists. For example, a video educational media tool supports patients’ decision-making by providing information related to different categories of care. This method has demonstrated efficacy in reducing decision conflict and increasing certainty in patients’ choice. Of note, most patients opted for comfort care.


  1. El-Jawahri A, Podgurski LM, Eichler AF, Plotkin SR, Temel JS, Mitchell SL, Chang Y, Barry MJ, Volandes AE. Use of video to facilitate end-of-life discussions with patients with cancer: a randomized controlled trial. J Clin Oncol. 2010 Jan 10;28(2):305-10.
  2. Back AL, Arnold RM, Baile WF, Fryer-Edwards KA, Alexander SC, Barley GE, Gooley TA, Tulsky JA. Efficacy of communication skills training for giving bad news and discussing transitions to palliative care. Arch Intern Med. 2007 Mar 12;167(5):453-60.
  3. Baile WF, Buckman R, Lenzi R, Glober G, Beale EA, Kudelka AP. SPIKES-A six-step protocol for delivering bad news: application to the patient with cancer. Oncologist. 2000;5(4):302-11.
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