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Implementing Serious Illness Communication Processes in Primary Care: A Qualitative Study.

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Summary

The Serious Illness Care Program (SICP) helps primary care teams conduct important patient conversations about serious illness. Implementation involved adapting the program to workflows, leading to earlier, more comprehensive communication and better care planning.

Keywords:
advance care planninggoals of care communicationimplementationpatient-clinician communicationprimary palliative careserious illness communicationworkflow

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Area of Science:

  • Healthcare delivery
  • Qualitative research methods
  • Patient-centered communication

Background:

  • Primary care clinicians encounter challenges in initiating serious illness conversations with patients.
  • Effective communication regarding prognosis, values, and goals is crucial for patient-centered care.
  • The Serious Illness Care Program (SICP) was developed to address these challenges in primary care.

Purpose of the Study:

  • To qualitatively explore the implementation of the Serious Illness Care Program (SICP) in primary care settings.
  • To understand the practical aspects and clinician experiences of integrating SICP into routine workflows.
  • To identify facilitators and barriers to adopting structured serious illness conversations.

Main Methods:

  • Semi-structured interviews were conducted with primary care physicians, nurse care coordinators, and social workers.
  • 14 clinicians from 6 primary care clinics participated until thematic saturation was reached.
  • Interview transcripts were coded to analyze activities supporting SICP integration into clinical workflows.

Main Results:

  • Clinicians adapted SICP components to fit busy workflows, implementing accountability processes to ensure conversations occurred.
  • Significant shifts in clinician mindset and norms were observed, including earlier initiation of conversations and broader prognostic communication models.
  • Evidence of sustainable behavior change and the expansion of communication practices beyond the program's initial scope was noted.

Conclusions:

  • The Serious Illness Care Program (SICP) provides a valuable framework for integrating serious illness communication into primary care.
  • Inter-professional teams developed adaptive workflows and comprehensive communication models for prognostic discussions.
  • The program facilitated proactive, longitudinal, and patient-centered serious illness conversations and care planning for patients with complex conditions.