availability of primary care physicians due to workforce shortages. Other obstacles to care planning identified by workshop participants included the increasingly complex medical data that healthcare providers need to consider when making treatment decisions, and a lack of decision support for healthcare providers (for example, in electronic health records) to aid in managing the complexity of medical information. In addition, the current reimbursement system for health care does not compensate providers for the time it takes to develop, discuss, and document a treatment plan.

Workshop participants also suggested a variety of mitigation strategies to address these many obstacles, including improved training of physicians, nurses, and other healthcare providers in the components of optimal communication with patients and families, and improved education of patients and families about how to be more proactive and assertive to optimize interactions with healthcare providers. Many participants advocated for greater use of support services, such as mental health services, social work, and nutrition counseling, as well as greater involvement of patient navigators who can help coordinate cancer care and foster communication among providers. However, others argued that the need for patient navigators is a symptom of a broken system, and strongly advocated for more structural, systemic reforms in cancer care. For example, many participants emphasized a need to change the reimbursement and financial incentives in the system to encourage and support more patient-centered care. They also stressed that greater use of quality improvement programs and accountable care systems could have a positive impact on the care provided to patients with cancer. A variety of tools and online resources were also cited as potential means to improve care planning, such as electronic health records that can organize all important medical information, share it with all members of the healthcare team, utilize decision support to better ensure optimal treatment recommendations for patients, and facilitate electronic input from patients into their healthcare records.

WHY PATIENT-CENTERED PLANNING FOR CANCER?

Cancer takes patients on a journey most have never taken before, whose outcomes are unknown. This creates uncertainty and anxiety, especially given the potential life-threatening nature of the disease, as several patients and providers noted at the workshop. Mr. Richard Boyajian, a cancer survivor and clinical director and primary nurse practitioner of the Adult Survivorship Program at Dana-Farber Cancer Institute, said that fear of the



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