Supporting Data vs Patient Requests in Oncology: When the Two Don't Coincide.

Relationships between cancer patients and their oncologists flourish in a milieu of trust and goodwill. However, at times cancer patients may express strong preferences for medical tests, treatments, or other interventions that are not beneficial. Actively challenging these requests can be difficult and may threaten the patient-physician relationship. However, failure to discuss why specific diagnostic or therapeutic interventions are not appropriate may be harmful to the patient and lead to inefficient use or overuse of healthcare resources. It is therefore crucial that oncologists steer patients away from unnecessary or harmful tests and procedures in an eloquent and respectful manner. In addition to utilizing individualized clinical reasoning, clinicians can also consult clinical practice guidelines to help respond to these requests using an external source of authority. However, guidelines may not always be sufficient. This article reviews this topic and provides recommendations from a community oncology practice perspective.