Serious Illness Care Program (SICP)
Communication in Serious Illness: An Innovative Approach to Clinical Care and Quality Improvement
Question: If you could implement one highly-effective approach to enhancing the care of patients with serious illness at your work site, what would it be?
Answer: "Surveys suggest that most Americans want to spend their final days at home, but many wind up dying in hospitals with aggressive care. And although people often want to discuss their end-of-life treatment options with their doctors, those conversations typically don't happen or happen too late to make a meaningful difference. Encouraging more end-of-life discussions between doctors and seriously ill patients can save costs, reduce stress among family members and—most importantly—improve the quality of life for people nearing death."
– Rita Redberg, M.D., M.Sc., is a cardiologist at the University of California, San Francisco (UCSF), and editor of the JAMA Internal Medicine.
Participants in this intensive, highly-interactive, two-and-a-half-day course, sponsored jointly by Ariadne Labs and the Harvard Medical School Center for Palliative Care, will learn about and practice an innovative approach to serious illness discussions and develop competencies in training others in implementing a Serious Illness Care Program (SICP) at their local institution. Derived from evidence-based best practices, the SICP is a multi-component intervention that aims to support clinicians in generating a personalized serious illness care plan for patients in the last year of life.
The course is designed to improve both learner competence and performance in practice. Learning methods will include project-based learning, including the development of cognitive maps for serious illness care discussions, demonstration, skills practice with feedback, and coaching on training and supporting clinicians and administrators in implementing the Serious Illness Care Program at participants’ home institutions.
The Serious Illness Conversation Guide, and the other elements of the Program, are based on an extensively piloted, evidence-based structure for communication about serious illness care. This model is currently being tested in a large randomized controlled trial at Dana-Farber Cancer Institute (DFCI), as well as implementation trials in primary care, pediatrics, nephrology, and pulmonary disease. Preliminary findings from the DFCI trial have been positive, and our goal is to disseminate this approach broadly. Patients who undergo the intervention report reduced anxiety levels after having the discussion. The intervention is viewed by clinicians as useful, simple, and highly effective in improving comfort and competence in conducting discussions about serious illness care goals.
Participants who choose to extend their involvement in this program will have the opportunity to apply for enrollment in the SICP Collaborative. In the SICP Collaborative, we will recruit and support a diverse group of institutions, caring for different populations of patients across the U.S., to implement and improve the Serious Illness Care Program, and evaluate its impact on patients and health systems. Sites that enroll in the Collaborative will receive the Implementation Package, extensive website materials, regular webinars, ongoing support from the Ariadne Labs team, and opportunities to share data, learning, and implementation experiences with other sites.
Upon completion of this activity, participants will be able to:
- Describe ways that improving communication about serious illness goals and values improves the quality of care received by patients with advanced illness and their families.
- Determine the benefits of early discussions about serious illness care goals on patient and family quality of life, medical decisions, resource use, and costs.
- Understand the principles of a checklist approach to complex care processes.
- Incorporate a checklist approach to improve performance of conversations about serious illness care goals, and receive personalized feedback about effective communication strategies.
- Evaluate strategies that are effective in engaging leadership and physicians, gaining system-wide buy-in for change, and evaluating the impact of implementing the Serious Illness Care Program.
- Utilize the Serious Illness Conversation Guide with their own patients.
- Describe the use of systems to support implementation and communication about this program (e.g., engaging clinicians and administrators, identification of high-risk patients, use of triggers and algorithms, and electronic record documentation templates).
- Use learner-centered educational strategies to train clinicians in the elements of the Serious Illness Care Program and the use of the Serious Illness Conversation Guide.
Who Should Attend?
We invite all physicians, nurses, and allied health professionals who work with patients and families with serious illness and who teach other clinicians about serious illness communication skills to attend this course.