New developments in oncology have led to a patient-centered approach in cancer treatment. Specifically, the introduction of targeted therapy has allowed oncologists to develop individualized treatment plans that target a patient’s tumor. However, this approach to cancer care remains a cancer-focused approach to treatment. It does not provide the specific needs and support that oncology patients require starting at the time of diagnosis.
Patients with cancer have many symptoms fears and expectations. The literature has shown that many patients with advanced cancer have unrealistic expectations about the effect of treatment and prognosis. At the same time, oncologists have little knowledge about the patient’s level
of understanding of their disease and their goals with treatment. Furthermore there is a lack of understanding about what a patient is willing to endure to achieve these goals. This miscommunication can result in unwanted tests, procedures and hospital stays that do not align with
the patient‘s goals of care. Methods to improve this communication gap are needed to provide better patient centered care.
Life-Sustaining Treatment Initiative (LSTI) is a national VA quality initiative from the National Center for Ethics in Health Care that was designed to improve communication between provider and patient by addressing a patient‘s understanding of their disease, eliciting their goals with treatment and what they are willing to endure to achieve these goals. It requires that providers document these discussion in a templated progress note that becomes part of the patient‘s health record. All VA facilities are required to implement this initiative by July 2018.
