Advance care planning, serious illness communication, and conversations to facilitate coping for patients with gastrointestinal malignancies: a narrative review

Ann Palliat Med. 2023 Sep;12(5):1059-1071. doi: 10.21037/apm-22-1261. Epub 2023 Jul 27.


Background and objective: Patients with advanced gastrointestinal (GI) malignancies are at high-risk for disease-related complications, treatment-related toxicity, unplanned hospitalizations, poor psychological outcomes, and short life-expectancies. Advance care planning (ACP) and serious illness communication (SIC) are two forms of communication that can help patients with GI malignancies explore the future, especially in the event of worsening health. While there are some limitations to traditional ACP, SIC that focuses on what matters most to patients with GI malignancies in the future (future-focused SIC), has the potential to improve future medical decision-making, help patients cognitively and emotionally process and accept their illness over time, help them feel heard and understood, allow them to positively cope with their disease, and may also help their caregivers in a variety of ways.

Methods: Narrative review using PubMed and Google Scholar to search for relevant literature published between 2010-2022.

Key content and findings: We present several key studies that highlight the complex, heterogenous nature of ACP and SIC research and its mixed outcomes for patients with GI malignancies. We also offer suggestions on how to optimize future-focused SIC research in this patient population. In the second half of this article, we suggest a practical approach to conducting future-focused SIC for patients with GI malignancies which includes a communication framework based on the literature and expert-opinion. We also provide practical tips on how to normalize these conversations and how to help patients use these conversations for future medical decision-making.

Conclusions: Future-focused SIC has the potential to benefit patients with advanced GI malignancies in a variety of ways. Optimizing research outcome measures that highlight the patient experience with this communication is crucial to move this area of research forward.

Keywords: Gastrointestinal cancer; advance care planning (ACP); communication; serious illness communication (SIC).

Publication types

  • Review

MeSH terms

  • Adaptation, Psychological
  • Advance Care Planning*
  • Caregivers / psychology
  • Communication
  • Gastrointestinal Neoplasms* / therapy
  • Humans