Investigators demonstrate that a dual intervention strategy improves patient comprehension of their condition while clarifying priorities for treatment.

New findings appearing in the June 2026 edition of JNCCN-Journal of the National Comprehensive Cancer Network reveal that brief, well-placed reminders sent to both individuals with cancer and their care teams at optimal times can markedly raise the occurrence of in-depth illness discussions.

The randomized trial conducted at Dana-Farber Cancer Institute examined two straightforward prompts intended to foster essential exchanges about treatment aims and personal preferences. One prompt took the form of an email alert to clinicians ahead of scheduled visits, while the other involved a mailed letter plus survey for patients. When used together, the prompts led to a notable rise in documented conversations.

"Earlier studies indicate these exchanges reduce patient distress, enhance well-being, and align care with individual objectives, especially toward the close of life," stated lead investigator Christopher R. Manz, MD, MSHP, of Dana-Farber Cancer Institute. "Conducting the discussion with a trusted provider and recording it in an accessible location enables the broader care team to respect patient preferences, particularly when the individual cannot speak on their own behalf."

The study enrolled 1,051 patients and 160 clinicians across two academic sites in four groups from December 4, 2022, through September 30, 2024. Participants with limited prognoses were assigned to receive either prompt type, both, or none. Those receiving the combined prompts showed 79 percent greater likelihood of a documented serious illness conversation within 60 days compared with the control group. Single-prompt arms produced smaller gains that did not reach statistical significance.

Researchers restricted prompts to patients beginning therapies linked with unfavorable outcomes and limited exposure to three visits.

"Precision matters most," explained co-lead author Cody E. Cotner, MD, of Harvard Medical School. "Alerting clinicians only for appropriate patients at the right moment avoids turning reminders into another source of overload. Clinician fatigue is genuine, and excessive alerts defeat their purpose by being overlooked. When patients receive preparatory outreach and arrive ready to consider what matters most, the resulting exchange starts more readily and reaches greater depth."

"This work brings practical encouragement to people facing advanced cancer and those treating them," observed Elise Carey, MD, a palliative care expert at Mayo Clinic Comprehensive Cancer Center who did not participate in the project. "It illustrates how a straightforward method-identifying higher-risk patients via standard oncology pathways and issuing simple reminders to both sides-can increase serious illness communication within everyday practice."

Dr. Carey, a member of the NCCN Guidelines Panel for Palliative Care, added: "The gains stemmed largely from the clinician prompt, indicating that modest, timely supports enable providers to create room for these vital talks amid demanding schedules. The findings represent a realistic, expandable approach to integrating such conversations into oncology care more consistently and earlier."

The full study, titled "Pathways to Advance Targeted and Helpful Serious Illness Conversations (PATH-SIC): A Randomized Clinical Trial," is available at JNCCN.org.

About JNCCN-Journal of the National Comprehensive Cancer Network
Over 25,000 oncology professionals throughout the United States consult JNCCN-Journal of the National Comprehensive Cancer Network. This peer-reviewed, indexed publication delivers current insights on oncology health services research topics such as quality and value in care, bioethics, comparative effectiveness, public policy, and supportive care studies. JNCCN presents updates to the NCCN Clinical Practice Guidelines in Oncology, guideline-related review articles, health services analyses, and commentary. JNCCN is issued by Conexiant. Additional details appear at JNCCN.org.

About the National Comprehensive Cancer Network
The National Comprehensive Cancer Network (NCCN) is a nonprofit alliance of leading cancer centers focused on patient care, research, and education. NCCN works to define and promote high-quality, effective, equitable, and accessible cancer care and prevention so that all individuals may live fuller lives. The NCCN Clinical Practice Guidelines in Oncology supply clear, evidence-based, expert consensus recommendations for cancer treatment, prevention, and supportive services; they serve as the accepted standard for clinical guidance and policy in cancer management and represent the most comprehensive and regularly updated practice guidelines in any medical field. The NCCN Guidelines for Patients furnish expert treatment information to inform and empower patients and caregivers with backing from the NCCN Foundation. NCCN further supports continuing education, worldwide programs, policy efforts, and collaborative research and publication in oncology. Visit NCCN.org for further information.

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SOURCE National Comprehensive Cancer Network