How do you counsel patients on the risks and benefits of chemotherapy or radiation offered with palliative intent?

Before I start counseling a patient on these decisions, I want to know a few things first.

1. I would want to know from the oncologists what they think the benefits are (i.e., how much more time might they get? Symptom control?) and what the risks are. The chances that the patient will see a benefit. And when they might see benefit (it is not uncommon for patients not to have a long enough prognosis to see these benefits). I also want to know how burdensome this treatment will be: how often will they get this treatment? How often will they need labs? Etc.
2. I also want to know from the rad onc how many fractions they are planning and the benefits/risks of this. If they are planning several fractions, I will often ask if they can have fewer frac...

When meeting a patient who is being referred for consideration of palliative radiation therapy, I always ensure that the patient is aware of their prognosis based on their primary disease, extent of disease, and KPS to help inform decision-making and what their expected prognosis would be with aggressive treatment vs. no treatment. Following this, I discuss with the patient their GOC for their disease and assess symptoms based on knowledge of their disease at the time of the consultation. Oftentimes, sadly, patients may present with multiple sites of symptomatic disease, and the goal is to determine which the patient feels is most detrimental to their QOL or may have the largest impact in the short term.

Following this, the discussion I have...