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

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.