A Person-Centered Approach to Oncology and Palliative Care

Abstract

The advent of evidence-based medicine (EBM) saw a marked improvement in clinical decision making when compared to the “this is what works best in my experience” approach, which preceded it. Aside from the fact that there is goodquality evidence available for only a fraction of treatments, a limitation of EBM is that it focuses primarily on identifying the best treatment of a disease and does not allow for differences in patients’ goals, priorities, and expectations or how they cope with their illness. This biomedical focus of EBM is particularly problematic for patients with chronic, incurable illnesses (which include many cancers), for whom a person-centered approach is superior. This article explores what it means to take a person centered approach to oncology and palliative care. In particular, the ambiguity of the term “personalized medicine” in oncology is considered, and seen to be represent a narrow version of “personalized”—in the sense of personalized car number plates and monogrammed shirts—not personalized in the sense of the treatment reflecting the patient’s values, goals, and expectations for care. Furthermore, taking a person-centered approach is an active process that does not equate with acquiescing to whatever the patient requests. As an example, in the emotional, high stakes decision to transition from cancer treatment to palliative care/ hospice or not, patients may reject hospice even when it’s in their best interests (i.e., hospice enrolment). A person-centered physician will understand this situation and attempt to advise the patient to choosing the initially disliked option that may be ultimately the right choice.