Serious Illness Conversation Training for Primary Care Residents: Feasibility, Effectiveness and Sustainability

Outcomes1. Describe the components of the modified SIC training, which may increase clinicians’ comfort levels in having ACP conversations.2. Discuss strategies to enhance clinicians’ ability to engage patients in ACP in primary care settings.Key MessageA modified version of the widely utilized Serious Illness Conversation (SIC) Training was incorporated into a Family Medicine residency program. Afterward, residents' comfort levels and likelihood to engage patients in SIC, as well as their self-assessed skillsets in conducting ACP, improved significantly, and was effectively sustained over 12-months post-training.BackgroundDespite recognition of its importance, advance care planning (ACP) uptake in primary care settings has been slow.ObjectiveTo evaluate the effectiveness of our modified SIC training for Family Medicine (FM) residents in increasing comfort levels in engaging patients in ACP and the sustainability of that effect, and to assess skillsets toward expanding the uptake of Serious Illness Conversations (SIC) in primary care settings.MethodsModified Ariadne Labs' SIC training was integrated into Oregon Health & Science University's second-year FM residency program. The training included didactic and in-person roleplays, followed by shadowing a nurse-ACP-coordinator while facilitating conversations with patients. Residents were surveyed along different timelines and interviewed two-months post-training. Data were analyzed using descriptive statistics and a Wilcoxon-signed rank test to compare changes over time. Interviews were transcribed and analyzed using a qualitative content analysis.ResultsNineteen residents participated November 2021 to June 2023. Participants’ comfort levels and likelihood to engage in ACP improved significantly on a 1-10 Liker scale (5.22à7.68: p< 0.001 and 6.33à 8.89: p< 0.01, respectively) when comparing before and after training, and were sustained up to 12-months in post-training surveys. Participants reported improved frequency to assist ACP (0=never; 4=all the time) increased from 2.0 (SD=0.0) before training to 2.44 (SD=+0.53) 12-month after and was statistically significant (p=0.046). Residents’ 12 self-assessed skillsets in conducting SIC improved significantly in their mean scores (all p< 0.005, before vs immediately after training), and were maintained up to 12 months. Participants cited roleplay and shadowing the nurse-ACP coordinator as the most helpful components of the training toward integrating ACP into their practice.ConclusionIntegrating modified SIC training into a FM resident program showed improvements in resident comfort levels, likelihood in engaging patients in ACP, and 12 self-assessed skillsets in conducting SIC, with potentially long-lasting impact toward making ACP part of routine care.KeywordsShared Decision Making / Advance Care Planning / Communication