REMINDERS, or ‘nudges’, either clinician- or patient-led, result in more serious illness conversations (SICs) between oncology providers and patients with poor-prognosis cancers, a new randomised controlled trial has found.1
Serious Illness Conversations
Serious illness conversations (SICs), while rare, aim to elicit patient preferences and are tied to improved quality of life.
Researchers reported that interventions are necessary to encourage more SICs for end-of-life care.
Chritopher R Manz, Dana-Farber Cancer Institute, Boston, USA, said in a statement: “Having the conversation with a provider they trust, and documenting it somewhere accessible, is what allows the rest of the team to honour the patients’ wishes, particularly if the patient is ill and unable to advocate for themself.”2
Encouraging SICs
The trial enrolled more than 1,000 adult patients at five oncology clinics between 4th December 2022 and 31st July 2024.1
All patients were starting a treatment associated with a poor prognosis, without documentation of an SIC in the electronic health records within six months prior.
Patients were randomised into four groups that received: a nudge through a mailed letter and questionnaire encouraging SICs, a clinician nudge comprising an email reminder the day prior to a clinic visit prompting an SIC, both nudges, and no nudges.
After 60 days, SIC rates recorded in the Advance Care Planning module of the relevant electronic health record were 10.7%, 16.7%, 10.6%, and 17.3% for the control, clinician-nudge, patient-nudge, and both nudges, respectively.
Overall, researchers reported, combined nudges resulted in significantly higher SIC rates, largely driven by the clinician.
They argued for future research to integrate both patient and clinician reminders with a view to increasing SIC rates, examining, through a patient-centred approach, perceptions of clinician communication.
References
1 Manz CR et al. Pathways to advance targeted and helpful serious illness conversations (PATH-SIC): a randomized clinical trial. JNCCN. 2026;DOI:https://doi.org/10.6004/jnccn.2025.7479.
2 National Comprehensive Cancer Network. Well-timed nudges help care providers to honor the wishes of patients with cancer according to JNCCN study. 2026. Available at: https://www.nccn.org/home/news/newsdetails?NewsId=5558. Last accessed: 24 June 2026.
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