ASCO Releases New Patient-Clinician Communication Guidelines

The American Society of Clinical Oncology (ASCO) has updated its Patient-Clinician Communication guidelines, which provide guidance to oncology clinicians on using effective communication to improve the patient-clinician relationship and well-being.¹ Feedback from medical oncologists, hematologists, nurses, hospice and palliative medicine clinicians, and communication skills and advocacy experts was used to create the new guidelines.

In a press release following the publication of these guidelines, co-author Timothy Gilligan, MD, an oncologist at Cleveland Clinic Cancer Institute and director of Communication Skills at the Cleveland Clinic Lerner College of Medicine, said, “High-stakes conversations with patients require careful planning and execution. Walking someone through information that may be very unwelcome requires a considerable degree of skill.”²

What are the Guidelines?

The guideline update addressed 11 clinical questions. They asked what communication skills and practices apply to:

1. Every visit across the continuum of cancer care?
2. Telehealth interactions?
3. Cross-disciplinary communication?
4. Discussion of prognosis and goals of care?
5. Treatment selection, including discussion of clinical trials?
6. End-of-life discussions?
7. Facilitating the involvement of the patient’s support network?
8. Overcoming barriers to communication?
9. Discussions of cost of care and financial toxicity?
10. Mitigating stigma?
11. Setting boundaries with patients?

In addition, a single educational question was addressed regarding the most effective ways for clinicians to learn to enhance their communication skills.

The guidelines provide in-depth recommendations and strategies to address all aforementioned questions. One recommendation from each posed question included:

1. Subject: Core Communication Skills With Patients and Their Support Networks
   1. Recommendation 1.1: Prior to each conversation, clinicians should review the patient’s medical information, establish goals for the conversation, and anticipate the needs and responses of the patient and members of their support network.
2. Subject: Telehealth and Communication
   1. Recommendation 2.4: Given the increased volume of telehealth encounters, organizations must construct and maintain systems to support and enhance clinician wellbeing.
3. Subject: Interprofessional Communication
   1. Recommendation 3.2: Implement strategies that foster a sense of belonging among team members and ensure that all team members are treated with respect.
4. Subject: Communication About Goals of Care and Prognosis
   1. Recommendation 4.1: Clinicians should provide diagnostic and prognostic information that is tailored to the patient’s needs while providing hope and reassurance without misleading the patient.
5. Subject: Communication About Treatment Options
   1. Recommendation 5.3: Discuss treatment options in a way that balances patient hope with a realistic assessment of likely outcomes, promotes autonomy, and facilitates understanding.
6. Subject: Communication About End of Life
   1. Recommendation 6.3: Clinicians should explore how a patient’s culture, religion, or spiritual belief system impacts their end-of-life decision-making or care preferences.
7. Subject: Involvement of the Patient’s Support Network
   1. Recommendation 7.2: Determine if a formal family meeting in a hospital or outpatient setting is indicated at important junctures in care. When possible, ensure that the patient, their designated surrogates, and desired medical professionals are present.
8. Subject: Addressing Barriers to Communication
   1. Recommendation 8.3: For a patient with physical limitations that may affect communication, incorporate strategies appropriate for physical abilities.
9. Subject: Communication About Cost of Care
   1. Recommendation 9.2: Clinicians should inquire if patients have difficulty with medical bills and refer patients to reliable sources if necessary.
10. Subject: Mitigating Stigma
    1. Recommendation 10.5: Recognize that when patients appear aggressive or respond with intensity, it could be a signal of unmet expectations, incomplete involvement in decision-making, high emotional or care needs, or merely the inherent difficulty of the situation. Respond accordingly if able to do so while ensuring your own physical and emotional safety.
11. Subject: Setting Boundaries
    1. Recommendation 11.1: For boundary crossings by a patient, whether with the clinician themselves or observed with another team member like a clinical colleague or trainee, communicate clear expectations and set clear limits.
12. Subject: Communication Skills Training
    1. Recommendation 12.3: Facilitators of communication skills training should have sufficient training and experience to effectively model and teach the desired communication skills and facilitate experiential learning exercises.

What are the universal pillars of communication in all health care conversations?

The study authors also noted that the broader literature they reviewed suggested that there were 4 communication practices that apply to nearly every conversation in health care. They were:

1. Establish an environment that is conducive to collegial communication
2. Collaboratively set an agenda
3. Actively foster trust and collaboration
4. When conversation partners display emotion through verbal or nonverbal behavior, respond empathetically.

How were the guidelines created?

A multidisciplinary expert panel developed the guideline based on a systematic review of the literature, clinical and lived experience, and a formal consensus process. Searches spanned from October 1, 2016, through January 16, 2025, and were limited to systematic reviews and randomized controlled trials.

The articles included those that had a population of adults; interventions consisting of in-person or telehealth communication between clinicians and patients with cancer, as well as receipt of communications skills training by clinicians; comparisons consisting of usual care, a different communication strategy, or nonreceipt of communication skills training; and outcomes such as patient, caregiver, and clinician satisfaction, quality of information conveyed by clinician, patient and caregiver understanding and retention of information, improved rapport, and improved health and well-being of patients and clinicians.

A total of 1892 publications were identified, and 164 were accepted based on title and abstract review. Following full-text review, 73 were eligible, of which 54 were systematic reviews and 19 were randomized controlled trials.

Following the compiling of articles, the recommendations and implementation strategies were drafted by subgroups of the expert panel, who were then supplemented by additional experts who were recruited to rate their agreement with the recommendations and strategies. To be accepted, each recommendation required 75% agreements among the consensus panel.

Once all recommendations were approved by the panel, ASCO staff added further edits, which were incorporated prior to public comment. Public comment was a period where the draft recommendations were released to the public from May 23, 2025, through June 6, 2025, and responses/feedback were gathered on each proposed recommendation. A total of 8 responses were received, and all changes were incorporated into the final manuscript review.

Related ASCO Guidelines and Standards

Currently, ASCO also has guidelines on:

• Palliative Care for Patients With Cancer
• Practical Assessment and Management of Vulnerabilities in Older Patients Receiving Systemic Cancer Therapy
• Telehealth in Oncology
• Fertility Preservation in People with Cancer
• Management of Anxiety and Depression in Adult Survivors of Cancer

References

1. Gilligan T, Bohlke K, Alpert AB, et al. Patient-clinician communication: ASCO guideline update. J Clin Oncol. 2026;44(11):1040-1057. doi:10.1200/JCO-26-00118
2. Getting tough conversations right in cancer care. News release. Cleveland Clinic. April 27, 2026. Accessed April 27, 2026. https://tinyurl.com/4ubfmjm6