Researchers were able to increase the percentage of Serious Illness Conversations (SIC) in outpatient oncology patients with the use of an interdisciplinary team that included a family partner.
“Standard of care in oncology practice is to discuss prognosis, treatment options, and end-of-life preferences—collectively known as serious illness conversations—early and for all patients with advanced cancer,” the researchers wrote. “Yet consistently, one third of patients with advanced cancer report never discussing end-of-life preferences, and when they do occur, only approximately 30% are with their primary oncologist.”
In an attempt to standardize and increase SIC, the researchers used an interdisciplinary team with an embedded family partner. The team included a palliative care physician trained as a SIC communication coach, three medical oncology clinicians, and advanced practice registered nurse, a family partner, a scheduling secretary, two registered nurse patient navigators, two social workers and one performance improvement specialist.
According to the researchers, the decision to include a family member “was based on emerging consensus that these partnerships improve health outcomes and better align care delivery to patient preferences.”
During the 18-month study period, three clinics identified 63 eligible patients. Patients were diagnosed with head and neck cancer (51%) or sarcoma (49%).
At baseline, the SIC rate was near zero. After the intervention, the SIC rate increased to 70%.
Conversations were interdisciplinary with 57% by the oncology MD, 14% by the advanced practice registered nurse, and 30% by the specialty palliative care.
According to the researchers, they have been able to maintain a stable median performance of 72%. Additionally, the mean time from patient identification to SIC decreased from 71 days to 39 days.
“Our approach demonstrated the feasibility of standardized team-based screening of every patient, inclusive of an embedded family partner and multiple disciplines, and is unique for oncology,” the researchers wrote.