Improving Communication About Serious Illness in Primary Care: A Review

Area of Science:

• Medical Communication
• Primary Care Medicine
• Serious Illness Care

Background:

• Systematic improvements are needed in clinician-led discussions about goals and care preferences for patients with serious illnesses.
• Such conversations are linked to better patient outcomes, increased clinician satisfaction, and reduced healthcare costs.
• The specific role of primary care in initiating and managing these crucial discussions remains unclear.

Purpose of the Study:

• To review the evidence on communication strategies for serious illness within primary care settings.
• To identify barriers faced by clinicians and system-level failures impacting these conversations.

Main Methods:

• A structured literature search was conducted using MEDLINE via PubMed.
• 911 articles were identified, with 126 selected for review based on relevance.
• Bibliography searches were used to identify additional relevant titles.

Main Results:

• Key themes identified include ambiguity in role responsibility (primary care vs. specialists) for initiating conversations and the quality/quantity of discussions.
• Clinician barriers include deficits in knowledge, skills, attitudes, discomfort with prognostication, and uncertainty about timing.
• System failures in coordination, documentation, feedback, and quality improvement impede effective communication.

Conclusions:

• Clinician and system barriers pose significant challenges to providing adequate care for seriously ill patients in primary care.
• Improving communication requires enhanced training, validated patient selection tools, systematic processes for conversations, accessible documentation, and incentives for quality improvement.