Anyone who cares for individuals with serious illness must live in a messy space where tough conversations about treatment decisions are common and complicated.   On today’s podcast we talk with James Tulsky about living in this messy space of medical decision making and the challenges that come with communication around advanced treatment decisions.  We talked about James’ path to the work that he has done, including early studies he did that included audio recording DNR discussions between physicians and patients, to his most recent study looking at the “Triadic agreement about advanced cancer treatment decisions.”      In this last study, James’ group surveyed 70 triads of patients, caregivers, and their oncologists shortly after making a cancer treatment decision and found that only 40% of triads completely agreed on the goal of treatment. In all of the remaining cases, at least one member of the triad disagreed about the goal of treatment.  So take a listen and also check out this wonderful ACP article that James did with Joshua Lakin and Rachelle Bernacki titled “Time Out Before Talking: Communication as a Medical Procedure” which we also discuss on the podcast.