Journal of oncology practice
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Conversations regarding goals of care with patients who have advanced cancer still occur too late, and oncologists say they lack the training to have these conversations effectively. Experts recommend a number of strategies when having these discussions, including discussing prognosis, responding to patient emotion, exploring values, and often making a recommendation for medical treatments that fit those values. To help learners, from residents to attending oncologists, learn these complex conversational skills, we have developed a framework with a mnemonic, REMAP: Reframe, Expect emotion, Map out patient goals, Align with goals, and Propose a plan. ⋯ If the patient gives permission, the oncologist will then use those values to propose a medical plan that matches patient values. The processes underlying REMAP encourage oncologists and other clinicians to seek to understand and remain flexible, adapting their recommendations to what they hear from the patient, with ongoing revision based on the shared decision-making process. This will lead to patient-centered decisions that promote better end-of-life care.
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Glioblastoma is the most common and most aggressive form of primary brain tumor in adults and contributes to high social and medical burden as a result of its incurable nature and significant neurologic morbidity. Despite ongoing research, there has not been improvement in survival in glioblastoma. ⋯ We review updates in management of newly diagnosed and recurrent glioblastoma, as well as common difficulties in management, such as pseudoprogression and pseudoresponse. Ongoing translational research in targeted therapy and immunotherapy is briefly discussed.