Dr Teresa Tate, Medical Advisor for Marie Curie Cancer Care and a consultant in Palliative Medicine at Barts and the London NHS Trust  

A commitment to open discussion and ready access to information is essential along the entire cancer pathway, but particularly for patients who may be approaching the end of their lives. The provision of information underpins the essential steps outlined in the End of Life Care Strategy, of the creation of advanced care plans, needs assessments for patients and carers, ongoing support for patients and carers, and of achieving, if possible, the patients’ wishes regarding their place of death.
 
Care for people nearing the end of life requires a co-ordinated, responsive approach, to ensure that they are treated as individuals, with dignity and respect. Effective communication with all patients and their families about every aspect of care is one of the keys to achieving this goal. It should include ensuring that patients have a clear understanding of the intended benefit, and likely outcome, of any proposed interventions, particularly novel drug treatments.
 
The recent NCEPOD report on deaths within 30 days of receiving chemotherapy highlighted the need to ensure that clinicians recognise that a patient is approaching the end of their life and that they are fully informed of the benefits and the risks involved in a decision to treat. The report found that verbal information was usually given by a doctor, but evidence of written information being provided was found in only about one third of notes reviewed. There is good evidence for the effectiveness of supporting the clinician’s conversation with written or recorded information which the patient can review later.
It is very important that clear and consistent information is provided to enable the patient to make decisions. It is also essential that the information given is accurately recorded to prevent confusing or conflicting conversations in the future.