Recognizing Goal-of-Care Misalignment in Palliative Radiotherapy: The Radiotherapy Room as an Early Clinical Sentinel.

BackgroundPalliative radiotherapy is an established symptom-directed treatment, but the treatment process may also reveal gaps between clinical intent, patient understanding, and family expectations.ViewpointThis Commentary places the radiotherapy room within the broader palliative oncology agenda of integrating tumor-directed treatment with patient- and family-centered palliative care. We argue that repeated radiotherapy encounters can help teams recognize possible goal-of-care misalignment before it becomes clinically disruptive.Practical implicationsConsistent goal language, early attention to family understanding, and simple pathways for recognition, reporting, and referral may support timely interdisciplinary reassessment. Radiation therapists should not replace physicians or palliative care teams in formal goals-of-care conversations, but their daily contact with patients can help identify early signals that further conversation is needed.ConclusionIncluding the radiotherapy room in palliative care communication may help align symptom-directed treatment with patient-centered goals.