Clinicians' Perspectives After Implementation of the Serious Illness Care Program: A Qualitative Study

Area of Science:

• Medical Communication
• Palliative Care
• Healthcare Quality Improvement

Background:

• Discussions about goals of care for seriously ill patients are often infrequent, late, and narrowly focused on resuscitation status.
• This can lead to care inconsistent with patient values and preferences.
• The Serious Illness Care Program (SICP) was developed to facilitate earlier, more frequent, and person-centered conversations.

Purpose of the Study:

• To explore clinicians' experiences and perceptions of the Serious Illness Care Program (SICP) one year after its implementation.
• To understand how the SICP influences clinician behavior and the nature of goals-of-care conversations.

Main Methods:

• A qualitative study involving semistructured interviews with clinicians at two tertiary care hospitals in Canada.
• The SICP, including clinician training and communication tools, was implemented at the study sites.
• Content analysis was used to evaluate interview data from 23 participating clinicians.

Main Results:

• Clinicians reported that the SICP supported behavioral changes through elements like unit champions and communication guides.
• The SICP shifted the focus of goals-of-care conversations beyond just code status, promoting more meaningful patient interactions.
• Clinicians experienced personal and professional influence, though concerns included time constraints and conversation fluidity.

Conclusions:

• The SICP effectively supports changes in clinician behavior and facilitates more meaningful goals-of-care conversations.
• Perceived benefits of the SICP contributed to its adoption within medical units.
• The SICP shows potential to foster cultural shifts in goals-of-care dialogue and improve care for hospitalized patients with serious illness.