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Improving serious illness communication : a qualitative study of clinical culture

Paladino, Joanna ; Sanders, Justin J. ; Fromme, Erik K. ; Block, Susan ; Jacobsen, Juliet C. LU ; Jackson, Vicki A. ; Ritchie, Christine S. and Mitchell, Suzanne (2023) In BMC Palliative Care 22(1).
Abstract

Objective: Communication about patients’ values, goals, and prognosis in serious illness (serious illness communication) is a cornerstone of person-centered care yet difficult to implement in practice. As part of Serious Illness Care Program implementation in five health systems, we studied the clinical culture-related factors that supported or impeded improvement in serious illness conversations. Methods: Qualitative analysis of semi-structured interviews of clinical leaders, implementation teams, and frontline champions. Results: We completed 30 interviews across palliative care, oncology, primary care, and hospital medicine. Participants identified four culture-related domains that influenced serious illness communication... (More)

Objective: Communication about patients’ values, goals, and prognosis in serious illness (serious illness communication) is a cornerstone of person-centered care yet difficult to implement in practice. As part of Serious Illness Care Program implementation in five health systems, we studied the clinical culture-related factors that supported or impeded improvement in serious illness conversations. Methods: Qualitative analysis of semi-structured interviews of clinical leaders, implementation teams, and frontline champions. Results: We completed 30 interviews across palliative care, oncology, primary care, and hospital medicine. Participants identified four culture-related domains that influenced serious illness communication improvement: (1) clinical paradigms; (2) interprofessional empowerment; (3) perceived conversation impact; (4) practice norms. Changes in clinicians’ beliefs, attitudes, and behaviors in these domains supported values and goals conversations, including: shifting paradigms about serious illness communication from ‘end-of-life planning’ to ‘knowing and honoring what matters most to patients;’ improvements in psychological safety that empowered advanced practice clinicians, nurses and social workers to take expanded roles; experiencing benefits of earlier values and goals conversations; shifting from avoidant norms to integration norms in which earlier serious illness discussions became part of routine processes. Culture-related inhibitors included: beliefs that conversations are about dying or withdrawing care; attitudes that serious illness communication is the physician’s job; discomfort managing emotions; lack of reliable processes. Conclusions: Aspects of clinical culture, such as paradigms about serious illness communication and inter-professional empowerment, are linked to successful adoption of serious illness communication. Further research is warranted to identify effective strategies to enhance clinical culture and drive clinician practice change.

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author
; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Clinical culture, Goals of care, Patient-provider communication, Quality improvement, Serious illness communication
in
BMC Palliative Care
volume
22
issue
1
article number
104
publisher
BioMed Central (BMC)
external identifiers
  • scopus:85165404708
  • pmid:37481530
ISSN
1472-684X
DOI
10.1186/s12904-023-01229-x
language
English
LU publication?
yes
id
fe94cd39-ff12-4c8c-8f74-1c546a71e9ad
date added to LUP
2023-08-25 15:15:25
date last changed
2024-02-19 23:47:17
@article{fe94cd39-ff12-4c8c-8f74-1c546a71e9ad,
  abstract     = {{<p>Objective: Communication about patients’ values, goals, and prognosis in serious illness (serious illness communication) is a cornerstone of person-centered care yet difficult to implement in practice. As part of Serious Illness Care Program implementation in five health systems, we studied the clinical culture-related factors that supported or impeded improvement in serious illness conversations. Methods: Qualitative analysis of semi-structured interviews of clinical leaders, implementation teams, and frontline champions. Results: We completed 30 interviews across palliative care, oncology, primary care, and hospital medicine. Participants identified four culture-related domains that influenced serious illness communication improvement: (1) clinical paradigms; (2) interprofessional empowerment; (3) perceived conversation impact; (4) practice norms. Changes in clinicians’ beliefs, attitudes, and behaviors in these domains supported values and goals conversations, including: shifting paradigms about serious illness communication from ‘end-of-life planning’ to ‘knowing and honoring what matters most to patients;’ improvements in psychological safety that empowered advanced practice clinicians, nurses and social workers to take expanded roles; experiencing benefits of earlier values and goals conversations; shifting from avoidant norms to integration norms in which earlier serious illness discussions became part of routine processes. Culture-related inhibitors included: beliefs that conversations are about dying or withdrawing care; attitudes that serious illness communication is the physician’s job; discomfort managing emotions; lack of reliable processes. Conclusions: Aspects of clinical culture, such as paradigms about serious illness communication and inter-professional empowerment, are linked to successful adoption of serious illness communication. Further research is warranted to identify effective strategies to enhance clinical culture and drive clinician practice change.</p>}},
  author       = {{Paladino, Joanna and Sanders, Justin J. and Fromme, Erik K. and Block, Susan and Jacobsen, Juliet C. and Jackson, Vicki A. and Ritchie, Christine S. and Mitchell, Suzanne}},
  issn         = {{1472-684X}},
  keywords     = {{Clinical culture; Goals of care; Patient-provider communication; Quality improvement; Serious illness communication}},
  language     = {{eng}},
  number       = {{1}},
  publisher    = {{BioMed Central (BMC)}},
  series       = {{BMC Palliative Care}},
  title        = {{Improving serious illness communication : a qualitative study of clinical culture}},
  url          = {{http://dx.doi.org/10.1186/s12904-023-01229-x}},
  doi          = {{10.1186/s12904-023-01229-x}},
  volume       = {{22}},
  year         = {{2023}},
}