Best practices for communication of prognosis and end-of-life discussions with patients with advanced breast cancer: A report from the advanced breast cancer global alliance.

Abstract

Purpose: Navigating prognosis and end-of-life (EoL) communications in advanced breast cancer (ABC) is difficult for healthcare professionals, people with the disease, and their caregivers. Greater multidisciplinary guidance is needed to optimise the effectiveness of these discussions.

Methods: In November 2023, the ABC Global Alliance held a multidisciplinary workshop at their annual meeting in Lisbon, Portugal, exploring practices in communicating prognosis and discussing EoL with people with ABC. Seventy-one participants from 27 countries participated in the workshop. Reference and insights from secondary research were reviewed and incorporated into the workshop findings.

Results: Workshop participants proposed a number of best practices for communicating prognosis and discussing EoL with people living with ABC, which aligned with four key topics: (1) When EoL discussions should happen - although individual preferences might differ, most participants felt this should be when life expectancy was within 6-12 months. (2) Who should be involved - if acceptable to the patient, presence of a care-giver or other family member should be encouraged. (3) What should be discussed- there was broad agreement for honesty with a realistic approximation of prognosis providing best and worst case scenarios all the time helping patients to maintain hope for plausible outcomes. (4) How EoL such conversations should be conducted- these sensitive conversations need to be conducted preferably by a Multidisciplinary Team Member (MDT) member who knows the patient and is trusted by them. Provision of a safe environment and plenty of time for discussion were seen as pre-requisites.

Conclusion: The workshop highlighted the complexity of EoL communication in ABC. Participants identified challenges and opportunities, and suggested best practices. While these approaches should be universally adopted, they must always be guided by patient preferences, considering individual and cultural differences to ensure compassionate and effective communication.