The prevalence of end of life decisions in current media and literature provides an opening for physicians to prompt conversations about the subject with patients, said Anthony Back, a Seattle Cancer Care Alliance medical oncologist, in remarks to the Palliative Care Oncology Symposium in Boston. Before beginning such difficult dialogue, however, he offered frameworks to facilitate end of life conversations both early and later on in a patient's disease trajectory. The Symposium was the first

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... ch hosted by the American Society of Clinical Oncology to promote discussion and integration of palliative care—a medical specialty designed to address physical, emotional and psychological symptoms of disease. The meeting drew an international audience of medical, radiation and surgical oncologists along with nurses, social workers and physician assistants. "This is a window of opportunity to get in the public dialogue in a really public way," Back said during a session addressing the skills required for optimum end of life care. Back pointed to The New York Times' widely-circulated coverage of Joseph Andrey and his daughter's struggle to honor his wish to die at home. Back also outlined social efforts underway nationwide as a result of a project that began in his home of Seattle, Death over Dinner, along the success of physician Atul Gawande's new book, Being Mortal. "This reflects the work done over the last 20 years that set the stage for this discussion," Back said. "Being Mortal wouldn't be on The New York Times' best-seller list if not for the work you are doing." He emphasized, however, that work remains to help physicians charged with navigating patients through the complex medical decisions they may face as they approach the end of their lives. "The task for physicians is the question of 'how do we get to telling patients that we will give them an extra layer of support to talking about the really tough stuff?'" Back said. Communication, he warned, is a learned expertise that must include frank, explicit discussi [...]