Discussion guides for medical oncology visits

As I was making slides for my talk titled From Diagnosis to Treatment to Survivorship: The Patient Perspective for #GI24, I had this idea to create Discussion templates called Discussion Guides that patients and clinicians could use at visits. These guides are aimed at Medical Oncologist visits for now, but can be adapted for use as needed by other specialties.

The thought was if there was a document that patients and their care team could refer to, it would help with the conversations they have at these visits. These can be printed and used as a guide for discussion or can be filled in by the patient or the clinician and sent home with the patient. Having a document that summarizes the visit is very helpful to patients as most of them may be hearing a lot of information for the first time and may have a hard time grasping everything that is discussed.

The Discussion Guides are divided into:

  1. At the 1st visit with the Medical Oncologist — At Diagnosis
  2. At the Treatment visit — During Treatment
  3. At the end of treatment for those who get to NED — During Surveillance/Survivorship
  4. At the time when cancer is no longer responding to treatment — End of Life visit

For each Discussion Guide, there is a version with leading questions, another that can be filled-in and a 3rd one which is a filled-in sample for reference. These could be nested under each.

1A. At Diagnosis Discussion Guide

This Discussion Guide can be used for the 1st medical oncology visit. In the top panel, there is space for a diagram to show where the cancer and metastases are located. Such a diagram is very useful to patients. The panel on the right on Disease Details So Far allows a discussion on what is known so far and what else is needed. The About The Patient section covers details about the patient that they want the care team to know, what their goals and priorities are. The treatment Overview section covers things like treatment intent, expected time-line, prognosis etc. At this 1st visit, this discussion can be a broad overview as more details about the cancer and molecular profiling results etc may not be available then. The last section has other topics that may be part of the discussion at this visit. The Next Steps section focuses on the immediate next steps, so the patient knows what to do next.

This shows a sample of the filled in At Diagnosis Discussion Guide with stage IIIB colon cancer as an example.

2A. During Treatment Discussion Guide

The During Treatment Discussion Guide gets a bit more into treatment and side effects, while keeping the patient goals of care front and center. This sample discussion guide is aimed at discussions around treatment for stage IIIB colon cancer. The various sections include Case Details So Far, Treatment Overview, Patient Goals of Care, Planned treatment for this specific patient, Side effects to expect & management, other topics to discuss.

3A. At Surveillance/Survivorship Discussion Guide

This At Surveillance/Survivorship Discussion Guide is for the follow-up visit after a patient is NED on imaging. This goes over the case details, treatments received and the Surveillance Plan. Here again the concerns the patient has currently is the main focus. Long term side effects, any other current patient concerns and referral to other care team members for mental health counseling, pelvic floor physical therapy etc are part of this discussion. 

4A. End of Life Care Discussion Guide

This Discussion Guide goes over Case details including treatment received and reviews the current goals of care in the background of the patient’s worsening disease. This guide goes over an Overview of End of Life care options, the End of Life Care Plan that the patient is comfortable with to hand over care and any other related topics to be discussed.

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