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

Abstract

The Serious Illness Care Program (SICP), designed by Ariadne Labs, is a multicomponent intervention to improve conversations about values and goals for patients with a life-limiting illness. In oncology, implementation of the SICP achieved more, earlier, and better-quality conversations and reduced anxiety and depression among patients with advanced cancer. In this commentary, we describe the SICP, including results from the cluster-randomized trial, provide examples of real-world implementation of this program, and highlight ongoing challenges and barriers that are preventing widespread adoption of this intervention into routine practice. For the SICP to be successfully embedded into routine patient care, it will require significant effort, including ongoing leadership support and training opportunities, champions from all sectors of the interdisciplinary team, and adaptation of the program to a wider range of patients. Future research should also investigate how early conversations can be translated into personalized care plans for patients.

Impact of a team-based versus individual clinician-focused training approach on primary healthcare professionals’ intention to have serious illness conversations with patients: a theory informed process evaluation of a cluster randomized trial

“…Still, as evidenced by our qualitative data, there is a great interest in other types of tools such as cheatsheets and EHR embedded tools. The findings are further corroborated by research conducted in other settings, where tools supplementing the SICG (e.g., SIC reminders, behavioural nudges) emerged as crucial elements in facilitating successful implementation (59)(60)(61)(62). Consequently, future interventions adapting the SICP to a primary care context should prioritize equipping PHCPs with a wider range of tools beyond the SICG.…”

“…This finding highlights a critical obstacle to large scale interventions: balancing the need for standardized content across diverse clinical contexts with the need to ensure adaptability to each practice’s specific needs (67–69). However, this limitation, combined with a process evaluation, enabled the identification of key SICP components critical for maintaining and replicating its effectiveness (5, 6, 59, 60). As Konnyu et al emphasize, mapping the potential for adaptation and intervention based on behavior change techniques is crucial for identifying potential gaps and optimizing interventions accordingly (70).…”

Adaptation of Serious Illness Care Program to be delivered via telehealth for older patients with hematologic malignancy

“… 32 In an outpatient oncology clinic at the Tom Baker Cancer Centre in Canada, implementation led to increased documentation of SICs at postintervention and documentation of 93% of conversations in the electronic medical record. 32 , 33 At the Abramson Cancer Center in Pennsylvania, the majority of patients (90%) reported that the SIC was worthwhile, with 55% reporting that the conversation increased their understanding of their future health, 42% reporting increased sense of control over future medical decisions, 58% reporting increased closeness with their physician, and 42% reporting greater hopefulness about quality of life. 32 , 34 Routine implementation of the SICP for older patients with AML or MDS may lead to increased SIC documentation, improvement in patient knowledge, and may promote patient hope and positivity.…”

“… 32 , 33 At the Abramson Cancer Center in Pennsylvania, the majority of patients (90%) reported that the SIC was worthwhile, with 55% reporting that the conversation increased their understanding of their future health, 42% reporting increased sense of control over future medical decisions, 58% reporting increased closeness with their physician, and 42% reporting greater hopefulness about quality of life. 32 , 34 Routine implementation of the SICP for older patients with AML or MDS may lead to increased SIC documentation, improvement in patient knowledge, and may promote patient hope and positivity. A single-arm pilot study is currently ongoing to evaluate the feasibility of the SICP for older patients with AML or MDS ( clinicaltrials.gov identifier: NCT04745676 ).…”

Physicians’ Lived Experience of Breaking Bad News in Clinical Practice: Five Essentials of a Relational Process

“…Moreover, physicians now initiate conversations about serious illness earlier with their patients, and they also continue these conversations throughout the clinical process (Back et al, 2009). This procedure has led to reduced anxiety and depression in some patients (Karim et al, 2022)-yet, the clinicians themselves still find it hard to discuss patients' prognoses and respond to their emotions (Geerse et al, 2019). Against this background, it is justified to question whether breaking bad news is all about delivering emotionally proper communication.…”