Patients whose clinicians were trained in the use of a Serious Illness Conversation Guide were much more likely to have more comprehensive documentation in the electronic medical record (EMR) of their goals, values and priorities.1 This is an early finding of a four-year randomized controlled trial that is currently being conducted at Dana-Farber Cancer Institute in Boston to evaluate the Serious Illness Care Program’s effectiveness.
“Patients also reported meaningful positive changes in their well-being through improved peace of mind, decreased anxiety or depression, realistic planning for the future, and improved relationships with their doctors,” reports Justin Sanders, MD, MSc, assistant director of innovation for the Serious Illness Care Program at Boston-based Ariadne Labs.
The Serious Illness Care Program is a multi-component intervention that aims to support clinicians in generating a personalized serious illness care plan for patients in the last year of life. Over 500 clinicians have been trained to date, and it is currently being piloted at multiple institutions.
“The Serious Illness Care Program aims to ensure care consistent with patients’ preferences by implementing systems changes that support clinicians to effectively learn about and act upon their patients’ values, goals, and priorities, as elicited through meaningful conversations in the right place at the right time,” says Sanders. The system changes involve the following steps:
• Identification of patients who have a high risk of death or disability due to their illness.
“In our trial with cancer patients, we have identified patients using the ‘surprise’ question,” Sanders says. Clinicians answered the question, “Would you be surprised if this patient died in the next year?”
If the clinician answered “no,” then the patient was eligible for enrollment in the trial. “This question has been shown to be predictive of one-year mortality in cancer patients and those with end-stage kidney disease,” Sanders says.
• Training clinicians to use evidence-based communication tools to improve the quality of their conversations.
One of these tools is the Serious Illness Conversation Guide. Clinicians use this guide to elicit illness understanding and information preferences, share a clear, direct prognosis according to those information preferences, to elicit hopes, fears, strengths, and priorities for their healthcare, and to learn about the kinds of communication patients are — or are not — having with their families and loved ones.
Clinicians are trained using a 2.5-hour session that involves reflection upon their current practice, skills training, and role-play. “This training has proven to be both feasible and highly acceptable to clinicians,” says Sanders.
• Documenting the conversations in ways that are accessible at multiple points of care.
Outcomes for the conversations are documented in a standardized location in the EMR. “Different healthcare systems, with different EMRs, are taking on the challenge of creating templates in their EMRs to record the kind of information that these conversations elicit,” says Sanders.
REFERENCE
- Bernacki R, Hutchings M, Vick J. Development of the Serious Illness Care Program: a randomised controlled trial of a palliative care communication intervention. BMJ Open 2015;5:e009032 doi:10.1136/bmjopen-2015-009032.
SOURCE
- Justin Sanders, MD MSc, Assistant Director of Innovation, Ariadne Labs, Boston. Phone: (617) 724-9509. Fax: (617) 643-6722. Email: [email protected].
