Patient Identification for Serious Illness Conversations: A Scoping Review

Area of Science:

• Palliative Care
• Medical Ethics
• Health Services Research

Background:

• Serious illness conversations are vital for aligning medical care with patient values, goals, and preferences.
• Effective patient identification is essential for timely initiation of these conversations.
• Current identification methods across diverse settings and populations lack comprehensive comparison.

Purpose of the Study:

• To examine and synthesize existing literature on patient identification for serious illness conversations.
• To focus on methods used within the Serious Illness Care Program and the Serious Illness Conversation Guide frameworks.
• To identify facilitators and barriers influencing patient identification processes.

Main Methods:

• A scoping review was conducted following Joanna Briggs Institute guidelines.
• Literature search across four databases for articles published between January 2014 and September 2021.
• Inclusion of 39 articles that met the predefined criteria.

Main Results:

• Patients were primarily identified using clinical/diagnostic triggers, the 'surprise question', or a combination of approaches.
• A wide range of healthcare professionals (physicians, nurses, allied health) and administrative staff, alongside automated algorithms, were involved in identification.
• Key facilitators and barriers impacting patient identification were elucidated.

Conclusions:

• Clinical triggers and the 'surprise question' are common methods for identifying patients for serious illness conversations.
• A multidisciplinary approach involving various clinical and non-clinical roles is utilized in patient identification.
• Further research is needed to evaluate adapted identification methods and clinician judgment in this process.