PLYMOUTH MEETING, PA — Patients with advanced cancer were significantly more likely to discuss and document their care preferences when both they and their physicians received targeted reminders, according to a randomized clinical trial published in the June 2026 issue of the National Comprehensive Cancer Network journal JNCCN, highlighting a potentially scalable approach to improving advance care planning in oncology.
The study, conducted by researchers at the Dana-Farber Cancer Institute, found that patients who received outreach before appointments while their clinicians received reminder emails had 79% higher odds of completing a documented serious illness conversation within 60 days compared with patients who received no intervention.
Researchers evaluated 1,051 patients and 160 clinicians across two academic cancer centers between December 2022 and September 2024. Participants were adults with poor-prognosis cancers who were beginning treatments associated with advanced disease.
Patients were randomly assigned to receive a mailed letter and questionnaire, a clinician reminder, both interventions, or neither. While the single-intervention groups showed modest increases in serious illness discussions, the combined approach produced the strongest results and was the only statistically significant improvement.
The conversations were documented as advance care planning discussions, a process designed to help ensure treatment decisions align with patients’ goals and preferences, particularly as illnesses progress.
“Past research has shown these conversations improve patient anxiety and quality of life and help them get care that matches their goals, especially near the end of life,” said lead researcher Christopher R. Manz, MD, MSHP, of Dana-Farber. “Having the conversation with a provider they trust, and documenting it somewhere accessible, is what allows the rest of the team to honor the patients’ wishes, particularly if the patient is ill and unable to advocate for themself.”
Researchers limited the interventions to patients beginning treatments associated with poor prognoses and restricted reminders to a maximum of three visits, an approach intended to avoid overwhelming clinicians with alerts.
“The key is precision,” co-lead author Cody E. Cotner, MD, of Harvard Medical School, said in a statement. “Nudging clinicians at the right time for the right patient rather than blasting reminders for every patient is how we turn this into a helpful quality improvement initiative rather than a burdensome email.”
The findings may carry implications for health systems seeking low-cost methods to improve advance care planning, an area that has received increasing attention as cancer care grows more complex and treatment options expand.
Elise Carey, MD, a palliative care specialist at the Mayo Clinic Comprehensive Cancer Center who was not involved in the research, said the results suggest that relatively simple interventions can improve communication between patients and oncology teams.
“What is especially striking is that the benefit was driven largely by the clinician nudge, suggesting that small, well-timed supports can help clinicians make space for these essential conversations even in a busy clinical practice,” Carey said. “Overall, this study offers a realistic, scalable step toward bringing serious illness conversations into oncology care earlier and more reliably.”
The study, titled Pathways to Advance Targeted and Helpful Serious Illness Conversations (PATH-SIC): A Randomized Clinical Trial, was published in the June 2026 issue of JNCCN. The journal said the findings suggest targeted outreach to both clinicians and patients may offer a practical way to increase advance care planning discussions among people with advanced cancer.
The full study is available at JNCCN.org.
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