Improving Critical Care Communication with the Serious Illness Conversation Guide at an Academic Medical Center.

Abstract

Professional societies have called for methods to improve serious illness communication training for critical care fellows and faculty. The Serious Illness Conversation Guide (SICG) is a best practice tool for discussing goals of care in an outpatient setting. Suitability of an ICU-tailored SICG was assessed by surveying critical care fellows and faculty. Impact of the ICU-tailored SICG training was assessed in CCS fellows by simulated patient encounters at baseline and 4-6 months post-training, and impact in CCS faculty was assessed by self-reported practice change three months post-training. In a 460-bed rural academic medical center, 12 critical care service (CCS) fellows and eight CCS faculty received a one-day palliative care faculty led SICG training tailored to the ICU context including for early and late goals of care discussions. A prospective prepost single institution design was utilized. Six of the seven suitability questions were statistically significantly in favor of SICG use in the ICU setting. CCS fellows demonstrated more use of the SICG components at 4-6 months after training compared to baseline (SICG component subscale 5.8 vs 9.3; P = 0.033) . CCS faculty reported implementation of the ICU-tailored SICG into their clinical practice after three months. The ICU-tailored SICG was suitable for the critical care setting, and training led to more comprehensive skills in CCS fellows and self-reported practice change in CCS faculty.