Co-Designing Solutions to Improve Communication About Serious Illness During Hospitalisation.

Area of Science:

• Healthcare Quality Improvement
• Patient-Centered Care
• Health Communication

Background:

• Serious illness conversations (SICs) are crucial for aligning care with patient priorities in life-limiting conditions.
• Barriers to SICs include patient understanding of medical information and provider challenges with documentation, training, and support.
• Patient-centered interventions are needed to address these barriers in hospital settings.

Purpose of the Study:

• To improve documentation and patient/caregiver and provider experiences during serious illness conversations (SICs) through co-design.
• To address barriers in serious illness conversations by developing tailored solutions.
• To enhance care aligned with patient values and goals.

Main Methods:

• A quality improvement project's final phase involved co-design workshops with patients, caregivers, and healthcare providers.
• Workshops were conducted on general internal medicine wards at a Canadian academic teaching hospital network.
• Twenty-five providers and 13 patients/caregivers participated in three workshops facilitated by human-centered design experts.

Main Results:

• Co-design workshops yielded principles (clear, compassionate, informed, reciprocal) guiding solution development for in-hospital SICs.
• Solutions included revised conversation guides, collaborative advanced care planning notes in electronic medical records, and a facilitator role for routine SICs.
• Patient, caregiver, and provider priorities informed the ideation and refinement of practical solutions.

Conclusions:

• Co-design identified key solutions: enhanced patient conversation guides, advance care planning notes, and Goals of Care Facilitators.
• These resources address barriers to high-quality SICs, improving patient and provider experiences and outcomes.
• Direct involvement of patients and caregivers in co-design is essential for developing effective SIC interventions.