A 52-Year-Old Man with Advanced Pancreatic Cancer Visits an Oncologist

A 52-year-old man with advanced pancreatic cancer visits an oncologist for a check-up. His cancer is incurable, and he has been on palliative care for the past three months. The patient and I had already discussed his prognosis. He's dropped 22.6 kg (50 lb) and is now too weak to play with his kids. He claims that during the visit, "I am a survivor, and I know I can overcome this. I'm going to do everything I can to be there for my kids." Which of the following is the best way to respond to this patient right now?

A) "I think it's important for you to know that your symptoms will likely worsen, but we will make sure you are as comfortable as possible."
B) "I'm glad you are able to maintain a positive attitude, but you and your family need to be prepared given your recent decline."
C) "Let's hope for the best while also making sure we talk about important decisions for your care if things turn out differently."
D) "You've been experiencing more weight loss and fatigue recently, and I want to make sure you understand the severity of that."
E) "You've been handling the physical challenges of this illness well but seem to be overlooking the emotional aspects of it."