Serious Illness Care Programme-contextual factors and implementation strategies: a qualitative study

Area of Science:

• Healthcare Implementation Science
• Palliative Care
• Health Services Research

Background:

• The Serious Illness Care Programme (SICP) is an evidence-based intervention designed to enhance communication about patient values and goals during serious illness.
• Successful implementation of such programs in real-world settings is complex and influenced by various factors.

Purpose of the Study:

• To characterize the implementation strategies used in three health system initiatives delivering the SICP.
• To identify contextual factors influencing the successful delivery and adoption of the SICP.

Main Methods:

• Qualitative thematic framework analysis of field notes from the initial 1.5 years of implementation.
• Fidelity survey to assess program adherence and effectiveness.

Main Results:

• Clinician training and electronic health record (EHR) templates for documenting serious illness conversations were successfully implemented.
• Clinician adoption of conversations was limited when training was the sole strategy, hindered by clinical culture.
• Visible leadership, champion facilitation, and automated EHR data feedback improved adoption, contingent on leadership support, champion capacity, and EHR capabilities.

Conclusions:

• Effective implementation of serious illness conversations requires multifaceted strategies beyond basic clinician training.
• Key strategies include EHR-based data feedback, engagement of specialty leaders, and sustained support from local champions.
• Favorable institutional context and attention to implementation strategies are essential for scaling improvements in serious illness care.