Implementation of a Serious Illness Conversation Program in a Health System: A Retrospective Observational Study.

BACKGROUND

Serious illness conversation (SIC) is a structured conversation framework designed to improve shared decision making and promote goal-concordant care with patients anticipating end-of-life care decisions.

OBJECTIVE

Examine reach, timeliness, and quality of SIC implementation across a health system after implementation of a SIC Program (SICP). Examine factors associated with SIC completion for eligible patients.

DESIGN

Retrospective observational cohort study of decedents eligible for SIC from 2022 to 2024 in a large health system in the United States.

MEASUREMENTS: Proportion of eligible patients with a documented SIC, demographic and clinical characteristics, timing of SIC relative to eligibility and death, number, and quality of SIC sessions.

RESULTS

About 7424 patients met the inclusion criteria, and half (49.5%) of those had SIC documentation. Of those, mean number of SICs was 3.6 (SD 5.56). First documented SIC included defined quality components 31.1% of the time. Factors associated with SIC included palliative care visits (OR 2.26, 95% CI 1.84, 2.78), a primary care provider in the system (OR 1.77, 95% CI 1.59, 1.96), and an inpatient admission with discharge to home care (OR 2.36, 95% CI 2.07, 2.70). Patients with dementia (OR 0.58, 95% CI 0.51, 0.66) were less likely to have SIC.

CONCLUSION

Systemwide implementation of an SICP engaged half of eligible patients; many of those had multiple documented conversations prior to death. More work is needed to engage eligible patients, especially those with dementia, and to improve conversation quality.