Adaptations to the Serious Illness Conversation Guide to Be More Culturally Safe

Abstract


 
 
 The Serious Illness Conversation Guide (SICG) has been shown to be an effective communication tool used by health care professionals when interacting with patients facing a life-limiting illness. However, Ariadne Labs, the originators of the tool, have not tested it with First Nations and Indigenous Peoples. In this project, the British Columbia Centre for Palliative Care and the First Nations Health Authority in British Columbia (BC), Canada collaborated to adapt the SICG to be more culturally safe for First Nations and Indigenous Peoples. Multiple feedback strategies were employed. Feedback was received from 35 older adults, Elders, and community members from two First Nations communities plus approximately 80 nurses serving in First Nations communities across BC. Key areas of focus for feedback on the clinical tool included setting up the conversation, involving family, closing the conversation, and using principles of health literacy to reduce power differences. Three questions were added in response to feedback received. By creating a safe space for dialogue, it is hoped that health care providers and family members will develop a deeper understanding of what is important to the person with a life-limiting illness. These conversations promote patient-centred health care that aligns with patient values and wishes. Findings from this project directly informed modification of the tool to support a more culturally safe conversation. Further research will inform whether this tool is culturally safe for all seriously ill people.
 
 

The Serious Illness Care Program in Oncology: Evidence, Real-World Implementation and Ongoing Barriers

“…Automatic triggers in the EMR also provide motivation to clinicians to initiate conversations with certain patients. Cultural adaptation of the guide has occurred to facilitate cultural safety and enhance patient and/or provider motivation to participate in conversations [37].…”

End-of-life communication strategies for healthcare professionals: A scoping review

“…49,50 It also prepares the patients and their families for subsequent communication. 62,74 These strategies may include the following:…”

“…(a) Assessing patients’ perceptions and understanding their diagnoses and prognoses; 14,17,24,27,30,37,48-50,52-54,58,64,67,75 (b) exploring and ascertaining the patients’ and families’ information preferences (e.g., details or summary, type of information); 14,17,24,30,34,37,48-50,52-54,67,75,76 (c) exploring patients’ concerns and problems; 36,66,72 addressing denials reflected as seeking out medically futile treatments, by exploring the reason for the requests before providing information; 49,54 being aware of patient cues (e.g., ‘I don’t know what to do about this’) and have deeper questioning; 37,49 (d) exploring patients’ emotional issues 9,12,24,36,53,64,77 and attitudes towards death; 54,77 (e) exploring patients’ concerns about cultural issues, such as asking questions about dignity 74 and their preference regarding the provider’s gender; 24,52,73 and (f) assessing patients’ readiness to talk about end-of-life topics by firing a warning shot, in which the negative news is mentioned briefly to prepare the patients before sharing the detailed news. 17,…”

“…Many publications have discussed communication strategies that involve including the family in end-of-life communications. 38,74,75 Multiple roles of families, such as those of surrogate decision-makers and informants, should be considered. 24,28,49,50,53,54,60,68,69,78,79 The related strategies are as follows:…”

Part of the solution: A survey of community organisation perspectives on barriers and facilitating actions to Advance Care Planning in British Columbia, Canada

“…After the successful adaptation of the Serious Illness Conversation Guide for Indigenous communities, the British Columbia Centre for Palliative Care is in the process of adapting it to culturally diverse populations. 35 Resources such as these, as well as the involvement of diverse nonprofits employing and serving various cultural groups and increased cultural-sensitivity training for healthcare providers, may begin to address this important barrier.…”