Vocational awe is (not) enough : Learnings from early adopters of serious illness communication
(2025) In Journal of Pain and Symptom Management- Abstract
CONTEXT: As part of a broader institutional initiative, the serious illness care program was implemented in a multi-site academic primary care practice. After 2 years, a minority was observed to be documenting serious illness conversations routinely.
OBJECTIVES: We aimed to learn about the motivations and actions of clinicians who routinely conducted and documented serious illness conversations.
METHODS: We identified primary care early adopters of serious illness communication: 17 of 228 physicians (roughly 8%) who were documenting at least 1-2 conversations every 1-2 months for a year. Fifteen physicians agreed to participated in semi-structed interviews and which were then analyzed with thematic analysis.
RESULTS:... (More)
CONTEXT: As part of a broader institutional initiative, the serious illness care program was implemented in a multi-site academic primary care practice. After 2 years, a minority was observed to be documenting serious illness conversations routinely.
OBJECTIVES: We aimed to learn about the motivations and actions of clinicians who routinely conducted and documented serious illness conversations.
METHODS: We identified primary care early adopters of serious illness communication: 17 of 228 physicians (roughly 8%) who were documenting at least 1-2 conversations every 1-2 months for a year. Fifteen physicians agreed to participated in semi-structed interviews and which were then analyzed with thematic analysis.
RESULTS: Early adopters successfully integrate serious illness conversations into clinical practice by using four strategies that amplify vocational awe: their deep sense of their professions core value. Three strategies focus on positive aspects of serious illness communication: (1) reflecting on the meaningful impact of serious illness conversations on clinical care; (2) feeling a resonance between serious illness communication and their personal identity and values; and (3) identifying with the medical community's sense that serious illness communication contributes to good clinical care. The fourth strategy is to minimize system limitations using a range of tactics that include accepting time shortages and streamlining workflow.
CONCLUSION: Vocational awe is a powerful driver for engaging in serious illness communication; however, without system-level resource support, it does not sustainably motivate most clinicians. Serious illness communication needs to be a part of routine healthcare with appropriately allocated time, compensation, and workflow support.
(Less)
- author
- Malecha, Patrick ; Drutchas, Alexis ; Klintman, Jenny LU ; Lindenberger, Elizabeth and Jacobsen, Juliet LU
- organization
- publishing date
- 2025-05-19
- type
- Contribution to journal
- publication status
- epub
- subject
- in
- Journal of Pain and Symptom Management
- publisher
- Elsevier
- external identifiers
-
- pmid:40398543
- ISSN
- 1873-6513
- DOI
- 10.1016/j.jpainsymman.2025.05.006
- language
- English
- LU publication?
- yes
- additional info
- Copyright © 2025. Published by Elsevier Inc.
- id
- b485e127-82cf-4c1a-acc9-b3754db663c7
- date added to LUP
- 2025-05-23 16:03:32
- date last changed
- 2025-05-26 07:44:26
@article{b485e127-82cf-4c1a-acc9-b3754db663c7,
abstract = {{<p>CONTEXT: As part of a broader institutional initiative, the serious illness care program was implemented in a multi-site academic primary care practice. After 2 years, a minority was observed to be documenting serious illness conversations routinely.</p><p>OBJECTIVES: We aimed to learn about the motivations and actions of clinicians who routinely conducted and documented serious illness conversations.</p><p>METHODS: We identified primary care early adopters of serious illness communication: 17 of 228 physicians (roughly 8%) who were documenting at least 1-2 conversations every 1-2 months for a year. Fifteen physicians agreed to participated in semi-structed interviews and which were then analyzed with thematic analysis.</p><p>RESULTS: Early adopters successfully integrate serious illness conversations into clinical practice by using four strategies that amplify vocational awe: their deep sense of their professions core value. Three strategies focus on positive aspects of serious illness communication: (1) reflecting on the meaningful impact of serious illness conversations on clinical care; (2) feeling a resonance between serious illness communication and their personal identity and values; and (3) identifying with the medical community's sense that serious illness communication contributes to good clinical care. The fourth strategy is to minimize system limitations using a range of tactics that include accepting time shortages and streamlining workflow.</p><p>CONCLUSION: Vocational awe is a powerful driver for engaging in serious illness communication; however, without system-level resource support, it does not sustainably motivate most clinicians. Serious illness communication needs to be a part of routine healthcare with appropriately allocated time, compensation, and workflow support.</p>}},
author = {{Malecha, Patrick and Drutchas, Alexis and Klintman, Jenny and Lindenberger, Elizabeth and Jacobsen, Juliet}},
issn = {{1873-6513}},
language = {{eng}},
month = {{05}},
publisher = {{Elsevier}},
series = {{Journal of Pain and Symptom Management}},
title = {{Vocational awe is (not) enough : Learnings from early adopters of serious illness communication}},
url = {{http://dx.doi.org/10.1016/j.jpainsymman.2025.05.006}},
doi = {{10.1016/j.jpainsymman.2025.05.006}},
year = {{2025}},
}