Experiences of Patients and Families Living with Cancer: Communication, Decision-Making, and Support

Abstract

Background: Cancer affects patients and families as a shared medical, emotional, and practical experience. This review examines how communication, decision-making, and caregiver support promote understanding, coping with uncertainty, and the enactment of care in the context of patients and their families. Methods: Targeted PubMed/MEDLINE searches and citation chaining were used to perform an integrative narrative review. Studies from 2019-2025 were selected, and influential earlier studies were included when clinically relevant. Studies were organized into three domains: communication, decision-making, and support, and were compared thematically with the aim of identifying common mechanisms and implications for practice. Results: The evidence yielded four recurring outcomes: shared understanding, emotional responsiveness, role clarity, and continuity. Patients and families valued clear, honest communication that was emotionally attentive and appropriately paced. Shared decision-making was most effective when options were clear, goals were elicited, family roles were discussed, and the patient's voice was preserved in discussions of family involvement. Information, symptoms, logistics, and treatment implementation were typically managed by caregivers; however, their preparedness and burden were not consistently assessed. Structured conversations, patient coaching, caregiver interventions, and early palliative care improved selected outcomes, although effects were not consistent across contexts or intervention designs. Conclusion: The coordination of communication, decision-making, and caregiver support should form a unified clinical process. Reassessment of understanding and information needs, decisional roles, family involvement, health literacy, caregiver capacity, and psychosocial needs can help align care with patient goals while reducing unnecessary uncertainty and caregiver burden.