A targeted prompting system significantly increased documented serious illness conversations for cancer patients, according to a new randomized controlled trial.
A targeted approach to initiating difficult conversations
A randomized controlled trial published in the June 2026 issue of JNCCN—Journal of the National Comprehensive Cancer Network found that the use of targeted prompts for both patients and clinicians was associated with a higher rate of documented serious illness conversations in cancer care. The study was conducted by researchers at the Dana-Farber Cancer Institute.
Study Design
The trial was conducted between December 4, 2022, and September 30, 2024, at two academic cancer centers. It included 1,051 adult patients with a poor prognosis and 160 clinicians. Patients were randomly assigned to one of four groups: no prompt (control), clinician-only prompt, patient-only prompt, or combined prompt (both patient and clinician).
- Clinician Prompt: A reminder email sent to clinicians prior to a scheduled appointment.
- Patient Prompt: A letter and questionnaire mailed to the patient.
- Prompts were limited to patients starting a treatment associated with a poor prognosis and were capped at a maximum of three visits per patient.
"Prior research has indicated these conversations can reduce patient anxiety and improve quality of life, helping patients receive care that aligns with their goals."
— Christopher R. Manz, MD, MSHP (Dana-Farber Cancer Institute)
Key Findings
- Patients in the combined prompt group had 79% higher odds of having a serious illness conversation documented as advance care planning within 60 days, compared to patients in the no-prompt group.
- The single-prompt groups (clinician-only and patient-only) showed a modest increase in documented conversations, but this result was not statistically significant.
Statements from Researchers and Experts
Christopher R. Manz, MD, MSHP (Dana-Farber Cancer Institute): Stated that prior research has indicated these conversations can reduce patient anxiety and improve quality of life, helping patients receive care that aligns with their goals, particularly near the end of life.
Cody E. Cotner, MD (Harvard Medical School): Emphasized the importance of precision, suggesting that targeting prompts at the right time for the right patient is a more effective quality improvement initiative than general reminders for all patients.
Elise Carey, MD (Mayo Clinic Comprehensive Cancer Center), who was not involved in the study, described the approach as a practical method to increase serious illness communication in routine cancer care. She noted that the benefit appeared to be driven largely by the clinician prompt.