We know that seriously ill patients who have conversations with their clinicians about their goals and wishes are more likely to have better outcomes fewer non-beneficial medical interventions, and better quality of life. Yet less than one third of patients with end-stage medical diagnoses report discussing their care goals and preferences with their clinicians. In fact, a survey of Massachusetts residents released by the Massachusetts Coalition for Serious Illness Care found that although 96 percent of respondents believed that discussing end-of-life care plans is important, only 10 percent have done so with their health-care provider and health care agent.

There are several barriers that make having conversations difficult across care settings:

  • Time constraints
  • Lack of the necessary skills and confidence among clinicians
  • Fear among clinicians that bringing up serious illness and end-of-life issues may be harmful to patients.
  • Uncertainty among clinicians about when it is appropriate to have these conversations
  • Confusion about who should initiate the discussion
  • Lack of systems to implement conversations and ensure quality and control
  • Shortage of palliative care specialists

The Serious Illness Care Program’s research is focused on how to address these barriers and best support non-palliative care clinicians to engage in these conversations with their seriously ill patients.

Testing the Serious Illness Care Program at the Dana-Farber Cancer Institute
Serious illness care in the primary care setting
Brigham and Women’s Faulkner Hospital/DCI Dialysis Unit
Serious illness care for chronic critical Illness settings
Serious illness care in emergency surgery settings
Serious Illness Care in African-American Patients and Families