Factors Shaping the Implementation of Serious Illness Conversations: Frontline Clinician Insights

Frontline clinicians are key to implementing Serious Illness Conversations (SICs), yet little qualitative research has examined how they experience its implementation in practice. This qualitatively driven mixed-method study explored clinicians' experiences with SIC Program implementation across diverse practice settings in British Columbia, Canada, guided by the Promoting Action on Research Implementation in Health Services (PARIHS) framework. Implementation barriers and facilitators were identified through semi-structured interviews and survey data that included open- and closed-ended questions. Clinicians valued the SIC Guide's credibility, reporting greater confidence and improved patient engagement during conversations when using the guide. Implementation of SICs was supported by leadership endorsement, peer networks, and integration into electronic health records, but constrained by documentation gaps, role confusion and limited mentorship following training. Rural clinicians highlighted strong relational continuity with fewer system supports, while urban clinicians reported the opposite. Nurses were prominent drivers of success, strengthening implementation fidelity and enhancing interprofessional collaboration. Findings affirm the utility of PARIHS but extend it by 1) positioning equity and cultural safety as essential contextual factors, 2) illustrating the overlap within domains of the PARIHS framework and 3) emphasizing the role of champions as facilitators to implementation.