ArticleBMC palliative care2023
Improving serious illness communication: a qualitative study of clinical culture.
Article in BMC palliative care, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
28 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Toward compassionate communication: a rapid review on facilitating the dementia disclosure process.Alzheimer's & dementia : the journal of the Alzheimer's Association · 2025Pooled it
- Exploring Patients' Perceptions of an Advance Care Planning Intervention in the Emergency Department: A Qualitative Study.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2025Trial
- Family carers' experiences of serious illness conversations in haematological malignancies - a qualitative interview study.BMC palliative care · 2026Article
- Development and Evaluation of a Survey to Assess Clinician and Organizational Factors Associated with Goals of Care Communication.Journal of general internal medicine · 2026Article
- Core Elements of Goals of Care Initiatives Across Eight Health Systems.Journal of pain and symptom management · 2026Article
- Values elicitation among surgical oncologists: Findings from an international survey.European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology · 2026Article
- Empowering Patient Autonomy: The Role of Large Language Models (LLMs) in Scaffolding Informed Consent in Medical Practice.Bioethics · 2026Article
- Talking about the hypothetical future: Serious illness communication for residents living with dementia in long-term care homes - An integrative review.Palliative care and social practice · 2026Review
- 'It's given us the opportunity': Patient and clinician experiences of serious illness conversations in the NHS acute setting - Results from a UK Qualitative Study.Palliative care and social practice · 2026Article
- Serious Illness Communication Training in Family Medicine Residencies: A National Study of Program Director Perspectives.Family medicine · 2025Article
- "What are you afraid of?" A mixed methods exploration of serious illness communication with oncology patients on general internal medicine wards in Canada.BMC health services research · 2025Article
- "There Should Be a Nurse on Call": Complex Care Needs of Low-Income Older Adults in Medicaid-Supported Assisted Living.Journal of palliative medicine · 2025Article
- Family satisfaction with the end-of-life discussions and resuscitation orders for patients with severe COVID-19: a multicenter study in Saudi Arabia.BMC medical ethics · 2025Article
- Perspectives of Patients on Communication and Involvement in Decision-Making during Palliative Care: A Qualitative Study in Rwanda.Rwanda journal of medicine and health sciences · 2025Article
- Experience implementing the serious illness care program through virtual training of multidisciplinary teams at a regional cancer centre.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2025Article
- Perceptions of Patient-Clinician Communication Among Adults With and Without Serious Illness.JAMA network open · 2025Article
- Attention to the Values, Wishes and Needs of Patients With Advanced Cancer by Hospital Clinicians, an Exploratory Qualitative Study.The American journal of hospice & palliative care · 2025Article
- Nursing-Led Early Palliative Care Referrals for Patients Receiving Chimeric Antigen Receptor T-Cell Therapy.Clinical journal of oncology nursing · 2025Article
- Determining timeframes to death for imminently dying patients: a retrospective cohort study.BMC palliative care · 2025Article
- Enablers and Barriers to Integrating Advance Care Planning in Chronic Kidney Disease Care in a Canadian Provincial Network.Canadian journal of kidney health and disease · 2025Article
Corrections and comments
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveCommunication about patients' values, goals, and prognosis in serious illness (serious illness communication) is a cornerstone of person-centered care yet difficult to implement in practice. As part of Serious Illness Care Program implementation in five health systems, we studied the clinical culture-related factors that supported or impeded improvement in serious illness conversations.
methodsQualitative analysis of semi-structured interviews of clinical leaders, implementation teams, and frontline champions.
resultsWe completed 30 interviews across palliative care, oncology, primary care, and hospital medicine. Participants identified four culture-related domains that influenced serious illness communication improvement: (1) clinical paradigms; (2) interprofessional empowerment; (3) perceived conversation impact; (4) practice norms. Changes in clinicians' beliefs, attitudes, and behaviors in these domains supported values and goals conversations, including: shifting paradigms about serious illness communication from 'end-of-life planning' to 'knowing and honoring what matters most to patients;' improvements in psychological safety that empowered advanced practice clinicians, nurses and social workers to take expanded roles; experiencing benefits of earlier values and goals conversations; shifting from avoidant norms to integration norms in which earlier serious illness discussions became part of routine processes. Culture-related inhibitors included: beliefs that conversations are about dying or withdrawing care; attitudes that serious illness communication is the physician's job; discomfort managing emotions; lack of reliable processes.
conclusionsAspects of clinical culture, such as paradigms about serious illness communication and inter-professional empowerment, are linked to successful adoption of serious illness communication. Further research is warranted to identify effective strategies to enhance clinical culture and drive clinician practice change.
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