Through Both Lenses: Patient–Clinician Dynamics in Serious Illness Conversations for Young Adults with Advanced Cancer

PURPOSE: Young adults (YAs) with advanced cancer face distinct medical and psychosocial challenges, making high-quality tailored communication essential. Yet the optimal timing and facilitation of serious illness conversations (SIC) remain variable. This study explores YA and multidisciplinary clinician perspectives on experiences with SIC. METHODS: Using a prospective, cross-sectional mixed methods design, we surveyed 98 participants 39 YAs aged 18-39 years with advanced disease across cancer types and 59 clinicians across disciplines and cancer specialties. Qualitative data, using basic qualitative description, were integrated to triangulate quantitative findings related to advance care planning (ACP) and palliative care (PC) understanding and to identify SIC barriers, facilitators, and readiness. RESULTS: YAs reported substantial emotional and career/education disruption from cancer. Nearly half (49%) were unsure about ACP, while others linked it with proxy decisions or end-of-life (EOL) planning. Clinicians broadly endorsed similar ACP topics, emphasizing care preferences, code status, and surrogate decision-making. Most YAs (59%) had limited PC knowledge and often equated it with EOL care. Shared SIC barriers included emotional toll and time limits, while a key facilitator was conversation initiation by the other party. Readiness for SIC was tied to emotional acceptance and clinical turning points. CONCLUSION: YAs with advanced cancer demonstrate varied awareness of ACP, PC, and experiences with SIC. Conversations typically arise at pivotal disease moments, a tipping point, requiring mutual readiness and recognition of changing realities by both patients and clinicians. Earlier and tailored communication may improve concordance of care delivered with YA values and preferences.