Effectiveness of Structured Communication Tools for Discussing Goals of Care in Cancer Care Settings: A Systematic Review

Abstract : Background and aim: Structured communication tools have been increasingly adopted in cancer care to support discussions on goals of care (GOC), symptom management, and psychosocial needs. However, evidence regarding their effectiveness across outcomes remains fragmented. The study aims to synthesize evidence on the effectiveness of structured communication tools used in cancer care settings for discussing goals of care, with a focus on patient, caregiver, and system-level outcomes. Method: A comprehensive search was conducted in databases including PubMed, Google Scholar, Clinical Key, and Cochrane Library from January 2000 to July 2025. Eligible studies included quasi-experimental trials, Randomized controlled trials (RCTs), cluster randomized trials, and cohort studies evaluating structured communication interventions. Two reviewers independently screened articles, extracted data, and assessed the Risk of bias using the ROB-I, ROB-I (Cluster), ROBINS-I V2, and ROBINS-E tools. Outcomes of interest were broadly encompassed, including quality of life(QoL), psychological status, patient satisfaction, decisional conflict, hospice utilization, and advance care planning. Due to heterogeneity in study designs and outcomes, a narrative synthesis was performed. Results: From an initial pool of 310 articles, 25 studies met the inclusion criteria. SCTs varied widely and included FLEX Care, end-of-life (EOL) care planning, communication training, Loop intervention, Serious Illness Care Program, PCAD pathway, GOC conversation, and an adapted end-of-life care module, etc. Studies reported improved QoL (n=10), psychological status (n=3), patient/staff/caregiver satisfaction (n=3), decisional conflict (n=2), hospice utilization, and advance care planning (n=7). Mean scores for psychological distress participants receiving FLEX Care®-enhanced psychosocial intervention experienced a significant reduction in psychological distress compared to participants in the control setting (p<0.001). EOL discussions were associated with lower rates of ventilation (AOR=0.26, 95%CI=0.08-0.83), resuscitation (AOR=0.16, 95%CI=0.03-0.80), ICU admission (AOR=0.35, 95%CI=0.14-0.90), and earlier hospice enrolment (AOR=1.58, 95% CI=1.04-2.63). while longer hospice stays were associated with better patient QoL (p=0.01) Conclusion: SCTs appear effective in improving the goals-of-care discussions in cancer settings, with benefits in care alignment and patient satisfaction. Implementation strategies and clinician training remain critical components for success.