Abstract 1516P
Background
The Serious Illness Care Program (SICP) is a system-based intervention and a conversation guide, which facilitates improved advance care planning (ACP) conversations between clinicians and seriously ill patients. The randomized control trial found the program reduced symptoms of depression/anxiety amongst oncology out-patients and improved process outcomes. We implemented the SICP in our center to determine if the effects of this program could be translated to the real world.
Methods
Two outpatient oncology clinics implemented the SICP, each over a 16-week period. Patients were identified based on an answer of “no” to the question “would I be surprised if this patient died within the next year?”, or any patient with a diagnosis of metastatic pancreatic cancer, or symptom scores of >7 on more than three categories of the patient reported outcome dashboard. Physicians were trained in the SICP conversation. 1 patient per week was identified and prepared to have the SICP conversation with the goal of at least 12 conversations in each 16-week period. Rates of documentation on our system’s “ACP and goals of care designation (GCD) Tracking Record” and GCD orders were recorded. Patient satisfaction and physician comfort level over time were assessed.
Results
16 patients were identified (8 patients in each 16-week period). One patient was lost to follow-up. Of the remaining 15 patients who had the SICP conversation, 14 (93%) had documentation on the Tracking Record and 8 (53%) had a GCD order. This was a major improvement over baseline rates of documentation (e.g. <1 % Tracking Record use and 16% GCD). 14 patients completed satisfaction surveys, of which 12 (86%) felt “completely” or “quite a bit” more heard or understood. Physician comfort level increased from 3.6 to 4.8 and from 4.8 to 5 out of 5, respectively over each 16-week period.
Conclusions
SICP implementation resulted in high rates of documentation of goals and preferences. Patients felt heard and understood by their healthcare team, and comfort in these conversations improved over time for physicians. The goal number of conversations was not met, but otherwise the SICP was feasible to implement in the real world. Further study is required to identify the appropriate triggers and barriers to routine SICP conversations.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Chief Medical Office (CMO)/Calgary Zone Medical Affairs (MA) Quality Improvement Initiative.
Disclosure
All authors have declared no conflicts of interest.