The Team-Based Serious Illness Care Program, A Qualitative Evaluation of Implementation and Teaming

Area of Science:

• Healthcare Management
• Clinical Communication
• Team-Based Care

Background:

• Early and frequent serious illness conversations align patient care with their goals and values.
• Nonphysician clinicians offer unique insights into patient wishes, supporting seriously ill patients.
• The Team-based Serious Illness Care Program (SICP) involved all care team members in these crucial conversations.

Purpose of the Study:

• To understand how care teams implement team-based approaches for serious illness conversations.
• To explore the navigation of team complexity in serious illness care.

Main Methods:

• A rapid qualitative approach analyzed semistructured interviews with 25 clinicians and stakeholders.
• The study focused on two SICP implementation groups: inpatient oncology and hospital medicine.
• Analysis utilized frameworks of cross-disciplinary role agreement, team formation, and organizational theory.

Main Results:

• Team-based SICP implementation was feasible, with adaptable communication strategies based on staffing stability.
• Leadership support at multiple levels facilitated program implementation.
• Benefits included distributed workload, timely conversations, and valuable input from nonphysician clinicians, though role ambiguity and conflict arose from miscommunication.

Conclusions:

• Team-based serious illness communication is a viable and valuable model.
• Successful implementation involves flexible workflows and effective leadership.
• Addressing communication and ethical conflicts is key to optimizing team-based serious illness care.