The Serious Illness Care Program: Implementing a Key Element of High-Quality Oncology Care
Pallavi Kumar, Joanna Paladino, Peter Gabriel, William J. Ferrell, Joshua Jones, Lynn M. Schuchter, Lawrence N. Shulman, Ravi B. Parikh
Abstract
SummaryPatients with cancer often experience physical and psychosocial distress and receive care that is unwanted or unwarranted, especially near the end of life. Serious illness conversations (SICs) — person-centered conversations about patients’ prognosis, values, and goals to inform treatment and care planning — are a key element of high-quality oncology care and decrease patient distress. Penn Medicine, a large academic health center, and the Abramson Cancer Center sought to address low rates of documented conversations by implementing the Serious Illness Care Program, an evidence-based care delivery innovation that includes communication tools, clinician training, and system changes. SIC reminders were targeted toward patients at high risk for 180-day mortality. The intervention led to a sustained quadrupling of rates of conversations and no negative impact on the quality of those conversations. In addition, the program was associated with decreases in aggressive end-of-life care, including chemotherapy in the last days of life. Penn Medicine’s experience describes how a structured program, along with senior leadership and a communication guide, can transform serious illness communication at a large academic health system.