For advanced cancer patients, from both societal and medical perspectives, many believe that the ideal decisions for care include participation in a well-designed clinical trial involving an investigational agent (i.e., phase I trial) and/or receiving high-quality palliative care, e.g., home hospice. However, despite the acceptance of these alternatives as ways of either improving future cancer care (in the case of phase I trials) or providing palliative care in an appropriate environment (as in hospice), they remain significantly underutilized. This relates to the difficult ethical issues, and overt dilemmas in the case of phase I trials, present in the advanced cancer patient care setting that create obstacles to effective communication and subsequent decision making. These obstacles include ineffective disclosure and understanding of the information necessary for such patients to set appropriate goals of care and make informed decisions. Building upon the involved investigators' prior efforts in examining the ethics of decision making among advanced cancer patients, the goals of this research project are to employ a combination of quantitative and qualitative methodologies to study the process of how and why advanced cancer patients seek information, e.g., regarding prognosis, and how they understand and use this information in the goal appraisal and decision-making processes. In addition, how oncologists communicate with advanced cancer patients about their illness, prognosis, and alternatives of care, and the obstacles present in achieving effective communication, will be studied. Such research will offer insights into engaging in effective communication with patients about complex issues, i.e., prognosis and participation in clinical research or hospice care. As well, data revealing areas of communication discomfort, or ineffective physician communication, should serve to explain the source of some patients' inaccurate conceptualizations of aspects of their care. Results from this research should highlight potential areas in need of improvement in physician-patient communication for both clinical care and clinical research. This research should also serve to suggest further areas of inquiry into the ethical aspects of the informed consent and decision-making processes, potentially improving the methods by which information, meaningful treatment choices and clinical research opportunities are made available to advanced cancer patients.
