Abstract
Background/objectiveOncology guidelines recommend earlier communication with patients about prognosis and goals‐of‐care in serious illness. However, current evidence leaves gaps in our understanding of the experience of these conversations. This analysis evaluates the patient and clinician experience of a conversation using a Serious Illness Conversation Guide (SICG).Design/settingSecondary analysis from a cluster‐randomized clinical trial in a northeastern cancer center.ParticipantsPhysicians, advanced practice clinicians, and patients with advanced cancer who received the intervention.InterventionSICG, clinician training, systems‐changes.Main outcomes and measuresThe patient questionnaire assessed perceptions of the conversation and impact on anxiety, hopefulness, peacefulness, sense of control over medical decisions, closeness with their clinician, and behaviors. The clinician questionnaire assessed feasibility, acceptability, and impact on satisfaction in their role.ResultsWe enrolled 54 clinicians and 163 patients; 41 clinicians and 118 patients had a SICG discussion. Most patients described the conversation as worthwhile (79%) and reported no change or improvement in their sense of peacefulness, hopefulness, and anxiety (on average 79%); 56% reported feeling closer with their clinician. Qualitative patient data described positive behavior changes, including enhanced planning for future care and increased focus on personal priorities. Nearly 90% of clinicians agreed that the SICG facilitated timely, effective conversations, and 70% reported increased satisfaction in their role.ConclusionConversations using a SICG were feasible, acceptable, and were associated with positive experiences for both patients and clinicians in oncology in ways that align with national recommendations for serious illness communication. This trial is registered at ClinicalTrials.gov: NCT01786811 https://clinicaltrials.gov/ct2/show/NCT01786811.
Highlights
Communication between clinicians and patients with serious illness about values and goals (“serious illness communication”) shapes the patient experience of care.[1]
Less is known about the impact of communication on other key domains of patient experience: feeling known as a person,[21,22] heard and understood by their care team,[23,24] having a sense of control over their medical decisions,[21,22] or occurrence of shared decision-making.[25]
We report a descriptive analysis of the experience of this structured conversation for patients with advanced cancer and oncology clinicians in the intervention group
Summary
Communication between clinicians and patients with serious illness about values and goals (“serious illness communication”) shapes the patient experience of care.[1]. To improve serious illness communication, we developed a communication quality improvement intervention, the Serious Illness Care Program, and tested it in a cluster-randomized clinical trial in outpatient oncology The foundation of this program is a Serious Illness Conversation Guide (SICG), a tool designed to support clinicians in having early, person-centered conversations with patients about their values, goals, prognosis, and preferences.[7,26-28]. In this manuscript, we report a descriptive analysis of the experience of this structured conversation for patients with advanced cancer and oncology clinicians in the intervention group The foundation of this program is a Serious Illness Conversation Guide (SICG), a tool designed to support clinicians in having early, person-centered conversations with patients about their values, goals, prognosis, and preferences.[7,26-28] In this manuscript, we report a descriptive analysis of the experience of this structured conversation for patients with advanced cancer and oncology clinicians in the intervention group
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