Best Practices and Communication Strategies for Informing Oncology Patients About Treatment Discontinuation and Transition to Palliative Care—A Practical Guide for Oncologists

TL;DR

This paper provides oncologists with practical strategies and a communication algorithm to help patients transition from active cancer treatment to palliative care in a compassionate and informed way.

Contribution

A structured, adaptable communication algorithm is proposed to guide oncologists in discontinuing treatment and transitioning to palliative care.

Findings

Structured communication strategies improve patient understanding and reduce unnecessary interventions.

A practical algorithm supports oncologists in balancing medical and patient-centered decision-making.

Timely integration of palliative care enhances the quality of end-of-life care.

Abstract

Discontinuing active oncological treatment and initiating palliative care is one of the most complex challenges in cancer care. This narrative review provides oncologists with practical guidance for these difficult conversations. Drawing on clinical guidelines, scientific literature, and expert opinion, we propose a structured communication strategy and introduce a practical algorithm to support informed and compassionate decision-making. This article aims to help clinicians balance medical accuracy with empathy while respecting patient values and preferences.

Discontinuing active oncological treatment and initiating palliative care is a critical moment in cancer care, requiring oncologists to address complex clinical, ethical, and emotional challenges. This narrative review aims to provide clinicians with practical guidance for conducting conversations about treatment discontinuation and transitioning patients to palliative or hospice care. Drawing from current clinical guidelines, empirical research, and expert perspectives, the article reviews evidence-based communication strategies and frameworks, including the SPIKES protocol, Ask–Tell–Ask, the WHO model, and the disclosure model. The article also explores the clinical, functional, psychosocial, and ethical criteria relevant to treatment withdrawal decisions, as well as the timing and structure of end-of-life discussions. A practical algorithm is proposed, synthesizing key principles into a step-by-step guide for use in daily oncology practice. The algorithm supports clinicians in balancing medical indications with patient values and preferences, fostering shared decision-making and maintaining therapeutic relationships even in the most difficult circumstances. The review concludes that structured yet flexible communication enhances patient understanding, reduces unnecessary interventions, and improves the quality of end-of-life care. By promoting patient-centered care and timely palliative integration, this article offers oncologists a clear and adaptable approach to one of the most sensitive aspects of cancer care.