Patient Readiness for Serious Illness Conversations: Identifying Psycho-Emotional Barriers Through a Phenomenological...

Serious Illness Conversations (SIC) are pivotal in aligning patient care with their values and preferences, yet many patients face barriers to meaningful engagement in these discussions. While readiness for SIC has been identified as a critical factor, little is known about the specific factors that hinder readiness.

This study aims to explore the barriers to patient readiness for SIC, focusing on emotional, cognitive, and coping-related factors. We seek to understand how these barriers manifest and affect patients' ability to engage in conversations about their goals, values, and priorities in the context of serious illness.

In this qualitative study, we employed interpretative phenomenological analysis (IPA) to analyse in-depth interviews with patients living with advanced cancer and participated in at least one SIC with their clinicians. Interviews were supplemented by fieldnotes taken during consultation observations. We use vignettes to situate barriers to patient readiness in the context of the participants' illness experiences and journey.

Eighteen participants were included in this analysis, seven of whom were evaluated to be unready for SIC engagement. We identified four key tendencies that impede readiness for SIC: disorientation, dislocation, deficit fixation, and disengagement. These tendencies were primarily rooted in maladaptive coping strategies and beliefs, such as avoidance, rumination, and catastrophic thinking.

Psycho-emotional barriers significantly hinder patient readiness for SIC. Addressing these barriers through targeted interventions could enhance patient engagement in these critical conversations, improving alignment between patient values and care decisions.