{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T03:48:53Z","timestamp":1782272933227,"version":"3.54.5"},"reference-count":19,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T00:00:00Z","timestamp":1773964800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Palliative Medicine"],"published-print":{"date-parts":[[2026,5,1]]},"abstract":"<jats:p>Patients facing serious illness may respond to distressing medical information with avoidance or denial, limiting their ability to engage in values-based decision-making. Exposure therapy\u2014an evidence-based psychological treatment for anxiety disorders\u2014offers conceptual tools that can inform communication and therapeutic approaches with patients who struggle with avoidance in the context of serious illness. This article describes the care of a patient with advanced cancer who declined prognostic and hospice conversations due to death-related anxiety. Drawing on core exposure therapy principles\u2014including safety, individualization, titration, and enhancement of coping\u2014we illustrate how serious illness communication strategies can be intentionally adapted to support patient engagement, reduce distress, and strengthen psychological resilience. Through techniques such as progressive disclosure, calibration of language potency, and the \u201ccontainer\u201d metaphor, clinicians can match communication to patients\u2019 emotional readiness, enhancing tolerance over time. Integrating exposures-informed approaches into palliative care practice helps bridge the gap between emotional avoidance and values-concordant care.<\/jats:p>","DOI":"10.1177\/10966218261431684","type":"journal-article","created":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T07:33:03Z","timestamp":1773991983000},"page":"671-674","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Avoidance: Exposure Therapy Informed Communication for Serious Illness Care"],"prefix":"10.1177","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-6219-7619","authenticated-orcid":false,"given":"Danielle","family":"Chammas","sequence":"first","affiliation":[{"name":"Department of Medicine, Division of Palliative Medicine, UCSF, San Francisco, California, USA."},{"name":"Department of Psychiatry and Behavioral Sciences, UCSF, San Francisco, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vicki","family":"Jackson","sequence":"additional","affiliation":[{"name":"Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA."},{"name":"Boston University Chobanian &amp; Avedisian School of Medicine, Boston, Massachusetts, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keri O.","family":"Brenner","sequence":"additional","affiliation":[{"name":"Department of Medicine, Section of Palliative Care, Stanford University, Palo Alto, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,3,20]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.v69n0415"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2008.02.007"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.19.00013"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMcp2304436"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2024.0317"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2017.0109"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2006.09.035"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1177\/00302228231167725"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1177\/10499091241300614"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1093\/med-psych\/9780190926939.001.0001"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-012-2077-6"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.brat.2022.104203"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.brat.2014.04.006"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.3322\/canjclin.55.3.164"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2017.2005"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.38103.423576.55"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1093\/med\/9780197525173.001.0001"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.5-4-302"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12904-023-01229-x"}],"container-title":["Journal of Palliative Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10966218261431684","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/10966218261431684","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10966218261431684","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T03:27:25Z","timestamp":1782271645000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/10966218261431684"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,20]]},"references-count":19,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,5,1]]}},"alternative-id":["10.1177\/10966218261431684"],"URL":"https:\/\/doi.org\/10.1177\/10966218261431684","relation":{},"ISSN":["1096-6218","1557-7740"],"issn-type":[{"value":"1096-6218","type":"print"},{"value":"1557-7740","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,20]]}}}