Vocational Awe is (not) Enough: Learnings From Early Adopters of Serious Illness Communication.

Abstract

As part of a broader institutional initiative, the serious illness care program was implemented in a multisite academic primary care practice. After 2 years, a minority was observed to be documenting serious illness conversations routinely. We aimed to learn about the motivations and actions of clinicians who routinely conducted and documented serious illness conversations. We identified primary care early adopters of serious illness communication: 17 of 228 physicians (roughly 8%) who were documenting at least 1-2 conversations every 1-2 months for a year. Fifteen physicians agreed to participate in semi-structed interviews and which were then analyzed with thematic analysis. Early adopters successfully integrate serious illness conversations into clinical practice by using four strategies that amplify vocational awe: their deep sense of their professions core value. Three strategies focus on positive aspects of serious illness communication: (1) reflecting on the meaningful impact of serious illness conversations on clinical care; (2) feeling a resonance between serious illness communication and their identity and values; and (3) identifying with the medical community's sense that serious illness communication contributes to good clinical care. The fourth strategy is to minimize system limitations using a range of tactics that include accepting time shortages and streamlining workflow. Vocational awe is a powerful driver for engaging in serious illness communication; however, without system-level resource support, it does not sustainably motivate most clinicians. Serious illness communication needs to be a part of routine healthcare with appropriately allocated time, compensation, and workflow support.