Adapting the Serious Illness Conversation Guide to Crisis Settings: A Qualitative Study

Outcomes 1. Upon successful completion, participants will be able to outline key skills and strategies for communication with patients and their families during crisis settings.2. Upon successful completion, participants will appreciate how the Serious Illness Conversation Guide may be adapted for crisis communication, for potential use in their clinical practice. Key Message There are limited tools to help physicians conduct serious illness conversations within a crisis situation, where there is a high probability of imminent death. The objective of our study was to identify the communication skills and strategies used by experts in crisis situations and to determine if and how the Serious Illness Conversation Guide (SICG) can be adapted for crisis. Introduction/Context There are limited tools to help physicians conduct serious illness conversations within a crisis situation, where there is a high probability of imminent death. Ariadne Lab's Serious Illness Conversation Guide (SICG) offers physicians a framework to lead conversations with seriously ill patients in stable settings. Though the SICG was designed in outpatient oncology, the patient-tested language and structured framework may also be adaptable to crisis communication. Objectives To identify the communication skills and strategies used by expert clinicians in crisis situations and to examine whether the SICG can be adapted for use in crisis situations Methods We conducted a qualitative analysis using semi-structured interviews. Data was analyzed by independent researchers via thematic analysis. We developed a preliminary adapted SICG based on the results. Setting/participants We interviewed general internists (n=8), intensive care physicians (n=3) and emergency medicine physicians (n=7) from Ottawa, Canada. All physicians worked at The Ottawa Hospital (a large tertiary care hospital). Results We identified four major themes : a) how crisis situations influence serious illness conversations, b) the key components required for crisis communication, c) the skills and strategies used to navigate difficult situations in crisis, and d) perceptions of adaptability of the SICG to crisis. All physicians felt the SICG could be adapted to crisis. The components of crisis communication that were identified to be absent from the existing SICG included: gathering information on the medical context and prior wishes, assessing capacity and establishing the substitute decision maker, gaining an understanding of the patient's quality of life and baseline function, and involving family. Conclusion Our study outlines key skills and strategies of crisis communication and supports a role for adapting the SICG to acute care. Future studies should test the preliminary adapted guide, seeking feedback from patient-advocates from culturally diverse populations. Keywords Shared Decision Making / Advance Care PlanningCommunication