Patient-Clinician

Telehealth Communicationa

Interprofessional

Patients and Others

Document Overview

Design and created by Guideline Central in participation with the American Society of Clinical Oncology.

Patient-Clinician Communication

American Society of Clinical Oncology

Publication Date: Mar 10, 2026

Page Last Updated: May 5, 2026

1.4.

Clinicians should provide information that is timely and oriented to the patient’s concerns and preferences for information. After providing information, clinicians should check for patient understanding and document important discussions in the health record.
Level of agreement 96%

Strategies

Avoid unnecessary delays in providing information.
Communicate with consultants and others involved in the patient’s care so that the patient receives coherent recommendations and information. Different clinicians may legitimately disagree with each other, but differences of opinion should be explained, and clinicians should actively help patients process and interpret differing recommendations.
Consider whether the information is appropriate to provide by phone, mail, or e-mail, or if an in-person meeting is needed.
Orient the patient, if necessary, to make sure they understand what will be discussed and why (e.g., “I have the results of the computed tomography [CT] scans you had done yesterday, and I wanted to go over the results with you if that’s ok.”).
Orient yourself to the patient’s understanding and concerns: Ask the patient what they know and what they want to know (e.g., “Please tell me what you understand, or what you have been told, about why you are in the hospital and what we are doing to help you get better.” “What have the other clinicians told you about your cancer?” “What are the things that you want to make sure we discuss today?”).
Use simple language tailored to the patient’s educational level. A patient may be intelligent and well educated but still have low healthcare literacy.
Avoid jargon (e.g., “response rate” or “positive test result”) and explain in lay language when you must use medical terminology.
Provide information that is relevant to what the patient wants to know and to the patient’s goals.
Avoid information overload by providing information in small chunks, stopping frequently, and checking for comprehension.
Check for understanding by using a “teach back” or “talk back” method, with a statement such as, “In your own words, what does this mean to you?” or “What will you tell your family or other members of your support network about what we discussed?”
Assure the patient that you are available to answer questions in the future and clarify how best to communicate after the visit.

6.1.

Clinicians should use an organized framework to guide the bidirectional communication about end-of life care with the patient and members of their support network.
Level of agreement 92%

Strategies

Use the principles and tools presented in published frameworks, such as SPIKES and the Serious Illness Conversation Guide.
Prepare mentally for discussions by anticipating the emotions of the patient and their support network, as well as questions about topics such as prognosis.
Review the health record for documentation of previous end-of life discussions and decisions.
Review information regarding previous end-of-life care discussions and decisions with the patient and whomever the patient would like to have included. This should include previous discussions and decisions about goals of care, cardiopulmonary resuscitation, hemodialysis, nutrition, hydration, and intensive care.
Develop rapport with the patient and members of their support network.
Ask patients and their support network about their preferences for information sharing.
Ask the patient and their support network what they understand about their medical situation.
Ask permission before sharing new medical information, including difficult news, prognostic information, or significant changes in treatment plan.
Provide information in small amounts, using plain direct language, avoid medical jargon and check understanding frequently.
Use a question prompt list to assist the patient in establishing questions they may want to discuss.
Address and express empathy for emotions throughout the conversation.
Ask the patient and members of their support network to define their goals in light of the medical situation. What is most important to them? What are their priorities? Explore sources of support including spirituality and religious beliefs.
Inquire if members of the patient’s support network are aware of the patient’s goals.
When appropriate, inquire about patient’s familiarity and understanding of hospice. Frame hospice services in the context of the patient’s expressed goals (e.g., “You stated being at home with your family is very important to you. Hospice is a program that focuses on keeping you at home and out of the hospital.”).
Summarize the conversation and establish a plan for the future.
Document end-of-life conversations in the health record.
For conversations incorporating highly complex, emotional, or high content load, spread the conversation over two or more visits.

6.2.

Clinicians should initiate conversations about the patient’s end-of-life preferences early in the course of incurable illness and readdress this topic periodically based on clinical events or preferences.
Level of agreement 92%

Strategies
Early in the course of incurable illness, within a month of diagnosis:

Discuss prognosis and advance care planning. Consider asking if the patient has thought about a situation during which they might not be able to make or express a decision regarding healthcare (e.g., “Advanced care planning allows us to discuss and document your wishes for treatment and care if you are unable to make medical decisions in the future due to illness or disability.”).
Document a surrogate decision maker and encourage the patient to complete an advance directive early in the course of disease (e.g., “Have you ever thought about who you would designate to make decisions on your behalf should something happen that would make you unable to make your own decisions?”).
Discuss why advance care planning is important and why the patient should discuss their goals, values, and care preferences with their appointed healthcare agent. Explain that this is a way to try to ensure that the care they receive is consistent with what they would want under different circumstances if they were not able to participate in decision-making.
Explore patient goals and values.
Anticipate that patient goals and preferences may change over time in response to disease and treatment-related factors as well as physical and emotional changes.
Recognize triggers or sentinel events that may prompt end of-life care conversations with the patient in the setting of advanced disease, including:
- Cancer progression.
- Decline in functional status.
- Increased high intensity healthcare utilization, including multiple emergency department visits, admissions to the hospital, (intensive care unit) ICU stays, or transition to a nursing facility if previously independent.
- Consideration of a new line of cancer-directed therapies in the setting of progression on or poor tolerance of previous treatments.
- Consideration of high-risk or high-burden medical or surgical interventions (e.g., hemodialysis, palliative surgery, feeding tube placement).
- Requests for care that don’t align with the patient’s clinical scenario.
- Requests from the patient or their supportive network for end-of-life care planning conversation.

8.2.

Focus on the most important points, use plain language, use a multi-media approach, and check frequently for understanding (see Recommendation 5.3).
Level of agreement 92%

Strategies

Assess health literacy with questions such as:
- How often do you fill out medical forms by yourself?
- How well do you understand written and numerical information in relation to your health?
- How important do you view your healthcare, and how much do you share responsibility for it with others?
- What sources do you use to find information about your health?
- How much control do you feel you have in relationships with your healthcare providers?
Assess for any physical disability (e.g., poor hearing or eyesight) that may affect the ability of the listener to understand the information the clinician is trying to convey.
Ask the patient how they prefer to receive medical information (e.g., verbally, in writing, with visual aids, big picture versus step-by-step details, etc.).
Encourage members of the patient’s support network to take notes during the encounter.
Ask the patient and their support network how comfortable they are with using technology.
Supplement discussions and education with written materials, video, computerized interactive tools, online resources, apps, and/or in-person sessions.
Be mindful of excessive use of apps and online resources, as it could deepen inequalities for those without access to technology.
Assess understanding throughout the discussion (e.g., teach back method) and before signing consents.
Encourage questions to clarify communication.
Use pictographs or other visual aids when available and describe absolute risk rather than relative risk. Written materials should be in plain language, use bulleted content, and contain images, graphs, or diagrams.
Use materials that are designed for people with low health numeracy, and use both words and numbers, describe the meaning of the numbers, and explain risks and benefits of treatment.

Recommendation Rating Definitions

Quality of Evidence
Term		Definitions
H	- High	We are very confident that the true effect lies close to that of the estimate of the effect
M	- Moderate	We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
L	- Low	Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect.
VL	- Very Low	We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect.

Strength of Recommendation
Term		Definitions
S	- Strong	In recommendations for an intervention, the desirable effects of an intervention outweigh its undesirable effects. In recommendations against an intervention, the undesirable effects of an intervention outweigh its desirable effects. All or almost all informed people would make the recommended choice for or against an intervention.
W	- Weak	In recommendations for an intervention, the desirable effects probably outweigh the undesirable effects, but appreciable uncertainty exists. In recommendations against an intervention, the undesirable effects probably outweigh the desirable effects, but appreciable uncertainty exists. Most informed people would choose the recommended course of action, but a substantial number would not.

GRADE Handbook, Schünemann, et al. 2013.

Document Overview

Document Title: Patient-Clinician Communication

Authoring Society: American Society of Clinical Oncology

Document Publication Date: Mar 10, 2026

Page Last Reviewed/Updated: May 5, 2026

Document Type: Guideline

Country of Publication: United States

Full Text Freely Available: Yes

Full Text Guideline: ascopubs.org/doi/10.1200/JCO-26-00118

Source Citation: Gilligan T, Bohlke K, Alpert AB, et al. Patient-Clinician Communication: ASCO Guideline Update. J Clin Oncol. 2026 March 10. doi: 10.1200/JCO-26-00118

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Scope: Counseling, Management

Keywords: Patient-Clinician Communication, Shared decision making, cancer, communication

Target Patient Population: Adults with cancer

Target Provider Population: Clinicians who care for adults with cancer.

Inclusion Criteria: Female, Male, Adult, Older Adult

Health Care Settings: Ambulatory, Hospice, Hospital, Outpatient, Radiology Services

Intended Users: Nurse, Nurse Practitioner, Physician, Physician Assistant

Recommendation Development Processes & Methodology

Supplemental Methodology Resources: Data Supplement Methodology Supplement

Number of Source Documents: 47

Literature Search Start Date: Sunday, January 1, 2006

Literature Search End Date: Saturday, October 1, 2016

Includes peer/external review process?: Yes

Includes public comment process?: No

Methodologist involvement?: Yes

Patient involvement?: Yes

Includes multi-disciplinary group?: Yes

Includes systematic review?: Yes

Grades quality of strength of evidence?: Yes

Grades quality of strength of recommendation?: Yes

Discloses funding source?: Yes

Discloses conflicts of interest?: Yes

Includes benefits/harms analysis with recommendations?: Yes

Identifies study selection process?: Yes

Identifies study selection criteria?: Yes

Identifies methods used to evaluate and analyze the evidence?: Yes

Identifies key questions addressed by the systematic review?: Yes

Identifies search strategy?: Yes

Patient-Clinician Communication