It’s nice to know that there is somebody thinking about these issues,’’ one patient shared, contrasting the conversation with his time in the ICU where he felt ‘‘powerless.’’
The Serious Illness Care Program envisions a world where every person with serious illness feels known and cared for on their own terms. The mission is to redesign care so that knowing and honoring patients’ priorities becomes the norm, not the exception. With this program:
- Leaders and teams receive tools, training, and technical assistance to build, scale, and embed new serious illness care models at their health systems and care delivery organizations.
- Clinicians receive tools, training, and support to improve their communication practices.
- Patients and families receive tools to engage in these important conversations at home.
A growing body of evidence supports the effectiveness and impact of the Serious Illness Care Program, including trials in primary care, oncology, and hospital medicine; numerous studies of the Serious Illness Conversation Guide with diverse patient populations; and program evaluations with health system partners. Evidence demonstrates that the program improves conversations and outcomes, such as lower anxiety and depression at end of life, for patients; results in a more skilled and better prepared clinician workforce; and is associated with lower costs of care at the end of life.
PATIENT, CLINICIAN, AND SYSTEM OUTCOMES
Patients:
Significant improvements in patient outcomes
- More conversations about values and goals (89% vs. 44%) and prognosis (91% vs. 48%).
- Conversations earlier in the illness course (5 months vs. 2.5 months before death).
- More accessible documentation of patients’ goals in the medical record (61% vs. 11%).
- Reductions in moderate to severe anxiety (10.2% control vs 5.0% intervention) and depression symptoms (20.8% control vs 10.6% intervention).
Positive experiences for patients
- 80% of patients found the conversation worthwhile.
- Patients reported:
- Better communication with their families: “It gave me focus, and I felt relieved after I spoke about some difficult stuff with them.”
- More planning for the future: “…[I am] more focused on goals I want to accomplish.”
- Enhanced planning for medical care: “…When I can no longer go [to the] bathroom by myself, I would like hospice house care.”
- Feeling closer to their clinician: “Mostly, the conversation brought us closer.”
Clinicians:
Positive experiences for clinicians
- 90% found the Serious Illness Conversation Guide effective and efficient to use.
- 70% reported more satisfaction in their role.
- ⅔ experienced less anxiety in having these conversations.
Systems:
While data from a randomized trial in advanced cancer showed no changes in healthcare utilization, evidence from a pragmatic trial in a primary care high risk care management program demonstrated changes in care delivery and costs at the end of life.
- $2,579 PMPM lower total medical expenses in the last 6 months of life ($4,143 in the last 3 months) for patients who had conversations compared to those who did not.
- Decedents in program-implementing clinics had 3x higher rates of hospice enrollment for > 30 days.
THE SERIOUS ILLNESS CONVERSATION GUIDE
The Serious Illness Conversation Guide is a structured communication tool based on best practices in person-centered communication. The tool has been used in training >28,000 clinicians nationally and globally. We estimate that the tool has reached >378,000 patients.
- Patient-tested, person-centered language
- High-quality communication techniques that build confidence and skills
- Emotionally supportive structure & flow
- Concise, efficient, and pressure tested in high stress clinical environments
- Adaptable for diverse patient populations and clinical contexts to promote equity
FUTURE RESEARCH
Ariadne Labs continuously seeks to identify important research questions and build the evidence base that will allow us to improve our tools and interventions. As we work to support health systems and clinicians to implement the Serious Illness Care Program, we will continue to research how best to simplify, synthesize, and spread the program. Current areas of priority research include:
- Identifying best practices in adapting and implementing the program across diverse organizational contexts.
- Growing our evidence base of the program’s effectiveness in improving equity and reducing disparities in care quality for racial minorities and marginalized communities.
- Evaluating SICP’s impact on patient experience using new validated measures that reflect our vision of humanizing health care, including feeling heard and understood & known and cared for as a person; and goal-concordant care (an elusive measure to date).
- Evaluating the impact of the program on clinician experience, well-being, and meaning at work.
- Exploring how program implementation can impact healthcare utilization.