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

Abstract

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