Four articles in this issue of JPM all bear-either directly or indirectly-on a problem that has been with us for more than two decades: how to talk with patients about a variety of issues likely to arise in the final phase of life from the communication of a dire prognosis to help with psychosocial and spiritual concerns at life's end.In "Doctor-Patient Communication about Advance Directives in Metastatic Breast Cancer," Sepucha et al. report that a full 87% of women with metastatic breast cancer had talked with their family and friends about end-of-life decisions, but only 19% had talked with a health care provider. This silence holds, despite the fact that a majority of the patients (88%) wanted to share decision making with their providers.
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