Serious Illness Communication in a Randomized Trial of a Nurse and Social Worker Palliative Telecare Team

Early serious illness communication (SIC) has numerous benefits for patients with cardiopulmonary illnesses, yet engaging patients in this complex, iterative communication process is challenging due to constraints on clinician time, limited clinician training in these conversations, and a lack of patient readiness. This study reports secondary SIC outcomes of a previously reported clinical trial.

In a randomized clinical trial of a nurse and social worker palliative telecare team, one visit with the nurse and/or social worker focused on SIC using a protocolized guide. Participants were at high risk of hospitalization or death, had poor health status, and chronic obstructive pulmonary disease and/or heart failure or interstitial lung disease. Documented SIC, advance directive (AD) completion, and the four-item readiness to engage in advance care planning scale (ACP-4) were measured at baseline and 6 months. Differences in change between intervention and usual care were analyzed using linear models and linear mixed models.

The 306 participants were on average 68.9 years, 90.2% male, 80.1% White, with multiple comorbidities (mean of 7.6). All outcomes were similar at baseline. ACP-4 increased more in the intervention group at 6 months compared to usual care (difference in change scores: 0.49; 95% CI 0.22-0.66, p < 0.001). Documented SIC at 6 months was higher in the intervention group compared to usual care (122/154, 79.2% vs. 7/152, 4.6%); adjusted difference in proportions 74.6% (95% CI 67.3-81.9, p < 0.001). The difference in proportion of participants with an AD at 6 months was not significant; adjusted difference in proportions, 0.01%, (95% CI -0.04-0.07, p = 0.64).

After participation in a telephonic, protocolized SIC intervention, documented SIC increased, and readiness to engage in ACP increased. Future research should evaluate how documented SIC is used and the effect of SIC on downstream outcomes of healthcare decisions and patient well-being.

ClinicalTrials.gov NCT02713347, https://clinicaltrials.gov/ct2/show/NCT02713347.