Use of the Serious Illness Conversation Guide to Improve Communication with Surrogates of Critically Ill Patients. A Pilot Study

Abstract

Background : International family-centered critical care guidelines recommend formal, structured communication to ensure that clinical decision making is informed by a shared understanding of diagnosis and prognosis and patient goals and preferences. Tools to facilitate these recommendations are limited. Objective : To examine the feasibility, acceptability, and utility of a standardized serious illness conversation (SIC) to guide communication between nonpalliative care trained providers and surrogates of critically ill, mechanically ventilated patients. Methods : After providers received training, including simulation, we implemented SIC in October 2018. A total of 11 hospitalist providers were eligible to perform SICs over the study interval. Providers met in person with surrogates of adult, mechanically ventilated patients in the medical intensive care unit within 48 hours of intubation. To determine acceptability, surrogates were surveyed 2 months after SIC completion, and providers were surveyed between June and July 2018. To determine feasibility and utility, two independent investigators reviewed SIC documentation and coded responses into categories. Results : Of 72 eligible patients, advanced care planning documentation was completed in 50 patients, including 36 SICs, for an advance care planning completion rate of 69% and an SIC completion rate of 50%. The average SIC was completed in 30 minutes, 3 days after intubation. Of the 19 surrogates surveyed, 95% found the SIC to be mostly or extremely worthwhile. Nine of 11 hospitalist providers completed the follow-up survey. Each of the nine providers who completed the survey found the guide valuable to patient care and easy to administer. The conversation yielded valuable information in terms of goals, fears, and worries; sources of strength; abilities critical to the patient; and understanding how much the patient would be willing to go through for the possibility of gaining more time. Conclusion : We found that implementation of a structured communication tool in the intensive care unit was feasible and acceptable to surrogates and providers; yet, fidelity to the timing and completion was modest. The tool appeared to yield valuable information for understanding the goals, fears, and care preferences of mechanically ventilated patients. Steps to increase fidelity, in accordance with family-centered care guidelines, are warranted.

Patient Identification for Serious Illness Conversations: A Scoping Review

“…It was suggested that relying solely on the SQ could overlook some patients who would benefit from a palliative approach [ 25 , 26 , 50 ]; similarly, replying ‘no’ to the SQ was not always thought to require a serious illness conversation [ 50 ]. Triggering criteria for a conversation did not guarantee that a conversation would be held, and without a structured tracking system it could be difficult for clinicians to know who had, or had not, completed serious illness conversations [ 35 , 43 ].…”

“…= 83 (62 y) 41 (55%) 45 (54%) Intervention and control patients had similar end-of-life health care utilization as measured by the mean number of NQF-endorsed indicators. Pasricha et al (2020) [ 43 ] U.S. To examine the feasibility, acceptability, and utility of a standardized SIC to guide communication between nonpalliative care trained providers and surrogates of critically ill, mechanically ventilated patients. Mixed-methods quality improvement pilot study.…”

Using Natural Language Processing to Classify Serious Illness Communication with Oncology Patients

“…In 2018, the University of Pennsylvania Abramson Cancer Center implemented the Serious Illness Care Program (SICP) developed by Ariadne Labs, a communication intervention designed to enhance timing, frequency, and quality of shared patient-provider decision-making in oncology. 19,20 Oncology clinicians are encouraged to document SIC using an EHR module, which generates a semi-structured "Serious Illness Conversation" note with subheadings by SIC domain. Prior to this implementation, all clinicians at Abramson Cancer Center were instructed to use an "Ad- "She doesn't want to experience any you willing to go through for the Limited hospitalizations, some testing and treatments; major side effects unless there is a possibility of gaining more time?…”

Diversity Concerns in Advance Care Planning

“…We salute recent efforts by Parischa and colleagues to improve communications in critical illness ( 1 ). This remains an area of healthcare disparity.…”