Well-Timed Nudges Help Care Providers to Honor the Wishes of Patients with Cancer According to JNCCN Study

Researchers find a two-pronged approach helps ensure people with cancer understand their illness better and share their priorities for care.

PLYMOUTH MEETING, Pa., June 15, 2026 /PRNewswire/ -- New research in the June 2026 issue of JNCCN—Journal of the National Comprehensive Cancer Network finds that small, targeted prompts delivered to both patients and providers at the right moment can significantly increase the number of serious illness conversations that take place.

The randomized controlled trial out of Dana-Farber Cancer Institute tested two simple nudges designed to encourage important conversations between patients with cancer and their oncologists about goals and preferences for care. One nudge consisted of a reminder email to clinicians prior to patients' appointments and another was a letter and questionnaire mailed to patients. When these nudges were combined, these conversations occurred significantly more often.

"Past research has shown these conversations improve patient anxiety and quality of life and help them get care that matches their goals, especially near the end of life," said one of the lead researchers, Christopher R. Manz, MD, MSHP, Dana-Farber Cancer Institute. "Having the conversation with a provider they trust, and documenting it somewhere accessible, is what allows the rest of the team to honor the patients' wishes, particularly if the patient is ill and unable to advocate for themself."

The clinical trial was conducted across four cohorts totaling 1,051 patients and 160 clinicians at two academic cancer center sites between December 4, 2022 and September 30, 2024. Adult patients with poor prognosis were randomized to either receive one of the two types of nudges, both nudges, or neither. Patients in the combined nudge arm had 79% higher odds of having a serious illness conversation documented as advance care planning within 60 days over the no-nudge group. The single-nudge groups also showed a modest increase, though not statistically significant.

The researchers deliberately limited the nudges to only patients starting a treatment that is associated with a poor prognosis and capped them at three visits.

"The key is precision. Nudging clinicians at the right time for the right patient rather than blasting reminders for every patient is how we turn this into a helpful quality improvement initiative rather than a burdensome email. Burnout is real and alert fatigue undermines the goal of these nudges: when they feel like noise, they get ignored," noted co-lead author Cody E. Cotner, MD, Harvard Medical School. "When a patient is prepared to have these conversations through initial outreach and walks into the office already thinking about what matters most to them, the clinician has a more receptive partner across the desk, and the conversation is easier to start and goes deeper."

"This study offers a practical dose of hope for patients with advanced cancer and the clinicians caring for them," commented Elise Carey, MD, a palliative care specialist at Mayo Clinic Comprehensive Cancer Center, who was not involved with this research. "It shows that a relatively simple approach—identifying high-risk patients through existing oncology treatment pathways and sending simple reminders to both patients and clinicians—can meaningfully increase serious illness communication in routine cancer care."

Dr. Carey, a Member of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines^®) Panel for Palliative Care, continued: "What is especially striking is that the benefit was driven largely by the clinician nudge, suggesting that small, well-timed supports can help clinicians make space for these essential conversations even in a busy clinical practice. Overall, this study offers a realistic, scalable step toward bringing serious illness conversations into oncology care earlier and more reliably."

To read the entire study "Pathways to Advance Targeted and Helpful Serious Illness Conversations (PATH-SIC): A Randomized Clinical Trial," visit JNCCN.org.

About JNCCN—Journal of the National Comprehensive Cancer Network
More than 25,000 oncologists and other cancer care professionals across the United States read JNCCN—Journal of the National Comprehensive Cancer Network. This peer-reviewed, indexed medical journal provides the latest information about innovation and scientific studies related to oncology health services research, including quality care and value, bioethics, comparative and cost effectiveness, public policy, and interventional research on supportive care and survivorship. JNCCN features updates on the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines^®), review articles elaborating on guidelines recommendations, health services research, and commentary. JNCCN is published by Conexiant. Visit JNCCN.org for more information.

About the National Comprehensive Cancer Network
The National Comprehensive Cancer Network^® (NCCN^®) is a not-for-profit alliance of leading cancer centers devoted to patient care, research, and education. NCCN is dedicated to defining and advancing quality, effective, equitable, and accessible cancer care and prevention so all people can live better lives. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines^®) provide transparent, evidence-based, expert consensus-driven recommendations for cancer treatment, prevention, and supportive services; they are the recognized standard for clinical direction and policy in cancer management and the most thorough and frequently-updated clinical practice guidelines available in any area of medicine. The NCCN Guidelines for Patients^® provide expert cancer treatment information to inform and empower patients and caregivers, through support from the NCCN Foundation^®. NCCN also advances continuing education, global initiatives, policy, and research collaboration and publication in oncology. Visit NCCN.org for more information.

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SOURCE National Comprehensive Cancer Network