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Related Experiment Video

Updated: Jun 25, 2025

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Implementing the Serious Illness Care Program in Safety Net Health Systems: A Qualitative Study.

Justin J Sanders1, Emily Benotti2, Carolina Jaramillo3

  • 1Ariadne Labs (J.J.S., E.B., C.J., B.S., N.D., N.S.M., E.F., J.P.), Boston, MA, USA; McGill University (J.J.S.), Montreal, QC, Canada.

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|May 30, 2024
PubMed
Summary

Implementing the Serious Illness Care Program in underserved communities faces unique challenges and barriers. However, mission-driven efforts and interprofessional practice can enable success, addressing unmet needs in marginalized populations.

Keywords:
Serious illness communicationsafety netunderserved populations

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Area of Science:

  • Health Services Research
  • Medical Communication
  • Health Equity

Background:

  • Quality improvement interventions for serious illness often do not reach marginalized and underserved populations.
  • Serious illness conversations improve care, but their implementation in systems serving these groups is understudied.

Purpose of the Study:

  • To explore factors influencing the implementation of the Serious Illness Care Program in health systems serving marginalized and underserved communities.

Main Methods:

  • Qualitative study using 16 interviews and 3 focus groups with 19 interdisciplinary team members.
  • Data collected from six diverse U.S. healthcare systems.
  • Template analysis with inductive and deductive coding to identify themes.

Main Results:

  • Key themes included patient factors, intervention elements, and health system context.
  • Enablers: mission-driven efforts, creativity, interprofessional practice, trainees.
  • Barriers: Serious Illness Conversation Guide limitations, resource constraints, socio-economic vulnerability, mistrust.

Conclusions:

  • Health systems serving marginalized communities face distinct challenges and possess unique assets for implementing the Serious Illness Care Program.
  • Implementation of such programs in low-resource settings can address unmet needs in underserved populations.