Is Training Alone Enough? A Comparison of Serious Illness Communication Training With and Without Implementation...

Area of Science:

• Medical Education
• Healthcare Quality Improvement
• Palliative Care

Background:

• Communication skills training alone has limited impact on serious illness conversations (SICs).
• Structured support strategies are needed to enhance SIC adoption and sustained use in clinical practice.
• The Serious Illness Care Program (SICP) was implemented to address these challenges.

Purpose of the Study:

• To evaluate the impact of the SICP on the adoption and sustained use of SICs.
• To compare the effectiveness of "Training Only" versus "Training with Implementation Support" modalities.

Main Methods:

• Retrospective review of SIC documentation frequencies at a single academic center (October 2020 - May 2023).
• Two intervention groups: Training Only and Training with Implementation Support (including patient identification, data feedback, coaching, incentives).
• Clinicians categorized by SIC documentation frequency (never, seldom, occasional, frequent) and sustained use (monthly documentation over six months).

Main Results:

• The "Training with Implementation Support" group showed significantly higher adoption rates and fewer "never users" compared to "Training Only" (57.6% vs. 78.9%, p < 0.01).
• Higher proportions of "seldom", "occasional", and "frequent" users were observed in the implementation support group.
• Sustained use was significantly greater in the "Training with Implementation Support" group (9.4% vs. 1.6%, p < 0.01).

Conclusions:

• Implementation support strategies are crucial for enhancing both initial adoption and sustained use of serious illness conversations.
• Integrating structured support beyond communication training is essential for successful SICP implementation.
• This approach improves the frequency and consistency of critical patient-clinician communication.