Creating a culture for change: Lessons from behavioral economics and complexity science to increase serious illness conversations for patients with cancer

Ramy Sedhom; Jasmine Tomita-Barber; Christopher R Manz; Ravi B Parikh; Arjun Gupta; Qasim Hussaini; David Dougherty

doi:10.1016/j.currproblcancer.2023.101020

Creating a culture for change: Lessons from behavioral economics and complexity science to increase serious illness conversations for patients with cancer

Curr Probl Cancer. 2023 Oct;47(5):101020. doi: 10.1016/j.currproblcancer.2023.101020. Epub 2023 Oct 15.

Authors

Ramy Sedhom¹, Jasmine Tomita-Barber², Christopher R Manz³, Ravi B Parikh⁴, Arjun Gupta⁵, Qasim Hussaini⁶, David Dougherty⁷

Affiliations

¹ Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA; Penn Center for Cancer Care Innovation, Abramson Cancer Center, Penn Medicine, Philadelphia, PA. Electronic address: ramy.sedhom@pennmedicine.upenn.edu.
² Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.
³ Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA.
⁴ Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA; Penn Center for Cancer Care Innovation, Abramson Cancer Center, Penn Medicine, Philadelphia, PA.
⁵ Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, MN.
⁶ Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD.
⁷ Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Penn Center for Cancer Care Innovation, Abramson Cancer Center, Penn Medicine, Philadelphia, PA.

PMID: 37863783
DOI: 10.1016/j.currproblcancer.2023.101020

Abstract

Patient-centered cancer care requires communication between patients and clinicians about patients' goals, values, and preferences. Serious illness communication improves patient and caregiver outcomes, the value and quality of cancer care, and the well-being of clinicians. Despite these benefits, there are competing factors including time, capacity, bandwidth, and resistance. Health systems and oncology practices have opportunities to invest in pathways that assist patients and clinicians to engage in serious illness conversations. We discuss how applying insights from behavioral economics and complexity science may help clinicians engage in serious illness conversation and improve patient-centered cancer care.

Keywords: Behavioral economics; Medical oncology; Palliative care; Serious illness communication.

MeSH terms

Communication
Economics, Behavioral*
Humans
Medical Oncology
Neoplasms* / therapy