Highlights
- Implementation of the Shared Decision-making with Otolaryngologists and Palliative care specialists (SOP) model is associated with a significantly higher frequency of multidisciplinary palliative care service utilization.
- The SOP model utilizes a structured three-step approach—choice talk, option talk, and decision talk—to align medical interventions with patient values.
- Patients in the SOP group showed an increased engagement with social workers, clinical psychologists, chaplains, and physiatrists compared to those receiving usual care.
- Early integration of palliative care in advanced head and neck cancer may improve the quality of end-of-life care and alleviate the high symptom burden associated with aggressive treatments.
Introduction: The Unmet Need in Advanced Oral Cavity Cancer
Advanced oral cavity cancer represents one of the most challenging malignancies in oncology, characterized by a profound impact on vital functions such as speech, deglutition, and respiration. Beyond the physical toll, patients often face significant psychological distress and social isolation due to the disfiguring nature of the disease and its treatments. While clinical guidelines increasingly advocate for the early integration of palliative care alongside curative-intent therapies, actual clinical practice often lags behind. In many healthcare settings, palliative care is still perceived as a last-resort intervention, leading to late referrals that occur only in the final weeks or days of life.
To address this gap, researchers have explored the Shared Decision-Making (SDM) framework. SDM is a collaborative process that allows patients and their healthcare providers to make medical decisions together, taking into account the best available evidence and the patient’s values and preferences. The study recently published in JAMA Network Open by Huang et al. investigates a specific application of this framework: the Shared Decision-making with Otolaryngologists and Palliative care specialists (SOP) model.
The SOP Model: A Structured Framework for Integrated Care
The SOP model is designed to break down the silos between surgical oncology and palliative medicine. It facilitates a proactive discussion about care goals at the time of diagnosis, rather than waiting for treatment failure. The model is structured into three distinct, sequential steps:
1. Choice Talk
In this initial phase, the otolaryngologist introduces the diagnosis and the various treatment and care options available. The primary goal of the choice talk is to inform the patient that a decision needs to be made and that their preferences are a critical component of that decision. This step shifts the dynamic from a paternalistic model of “prescribing” a treatment to a collaborative model of “choosing” a path.
2. Option Talk
Facilitated by case managers and palliative care specialists, the option talk involves a deep dive into the specifics of the available treatments, including concurrent chemoradiotherapy (CCRT), surgery, and supportive care. This phase focuses on the risks, benefits, and potential outcomes of each path. For patients with stage IV oral cavity cancer, this includes honest discussions about the impact of treatment on quality of life and the role of multidisciplinary support.
3. Decision Talk
The final step is the decision talk, where the patient, their family, and the clinical team arrive at a consensus that aligns with the patient’s personal values and life goals. By involving palliative care specialists at this stage, the model ensures that supportive care is integrated into the treatment plan from the outset, rather than being an afterthought.
Study Design and Methodology
This prospective cohort study was conducted at a national referral center, comparing outcomes before and after the implementation of the SOP model. The study population included 430 eligible patients, of whom 110 were ultimately analyzed. All participants had newly diagnosed stage IV oral cavity cancer and were undergoing concurrent chemoradiotherapy (CCRT).
The participants were divided into two groups: the SOP group (n = 52), who were treated between 2020 and 2021 following the model’s implementation, and the non-SOP group (n = 58), who received usual cancer care between 2018 and 2019. The demographic profile of the cohort was predominantly male (93%), with a mean age of approximately 58 years, reflecting the typical epidemiology of oral cavity cancer.
The primary outcome measure was the composite frequency of multidisciplinary palliative care service utilization before death. This included consultations with palliative care specialists, social workers, clinical psychologists, chaplains, and physiatrists. The researchers utilized univariate and multivariate linear regression analyses to adjust for potential confounders and determine the association between the SOP model and medical resource utilization.
Key Findings: Bridging the Support Gap
The results of the study indicate that the SOP model successfully increased the engagement of patients with supportive services. The SOP group demonstrated a significantly higher frequency of multidisciplinary palliative care consultations compared to the non-SOP group. Specifically, multivariate linear regression revealed a positive association (β = 0.49; 95% CI, 0.11-0.87; P = .01).
Detailed analysis showed that the increased utilization was not limited to just end-of-life care but was distributed throughout the treatment trajectory. By involving case managers and specialists early, patients were more likely to access psychological and social support, which is often neglected in the high-pressure environment of acute oncology treatment. Furthermore, the study monitored medical resource utilization and found that the SOP model did not lead to an inappropriate increase in acute care costs, but rather redirected resources toward comprehensive supportive care.
Expert Commentary and Clinical Implications
The success of the SOP model highlights the importance of structural changes in the outpatient setting. For many clinicians, the barrier to palliative care is not a lack of will, but a lack of a clear pathway for referral and discussion. By embedding SDM into the standard workflow of an otolaryngology clinic, the SOP model normalizes the presence of palliative care specialists within the oncology team.
However, several considerations must be noted. The study population was predominantly male, which is consistent with head and neck cancer demographics but may limit generalizability to other populations. Additionally, the study was conducted at a single national referral center; the scalability of the SOP model in community hospitals or resource-limited settings remains to be seen. The role of the case manager was also pivotal in this study, suggesting that manpower and coordination are essential ingredients for the model’s success.
From a biological and clinical perspective, the early integration of physiatrists is particularly noteworthy. Patients with oral cavity cancer often suffer from trismus, dysphagia, and neck fibrosis following radiation. Early physiatry involvement can mitigate these functional declines, illustrating that palliative care is about maximizing life and function, not just managing death.
Conclusion
The implementation of the Shared Decision-making with Otolaryngologists and Palliative care specialists (SOP) model represents a significant step forward in the management of advanced oral cavity cancer. By structuring the decision-making process into choice, option, and decision talks, the model ensures that multidisciplinary palliative care is not merely an optional add-on but a core component of the treatment journey. Broader adoption of such models could fundamentally transform the quality of care for patients facing the daunting challenges of advanced head and neck malignancies.
References
Huang HL, Cheng SY, Tsai JS, Su HY, Lin YC, Kang YC, Lee SY, Chen YW, Lin HJ. Shared Decision-Making With Otolaryngologists and Palliative Care Specialists in Oral Cavity Cancer. JAMA Netw Open. 2025 Dec 1;8(12):e2548557. doi: 10.1001/jamanetworkopen.2025.48557. PMID: 41379446; PMCID: PMC12699358.
