ArticleBMC health services research2025
"What are you afraid of?" A mixed methods exploration of serious illness communication with oncology patients on general internal medicine wards in Canada.
Article in BMC health services research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundWhile emphasized as a key aspect of patient-centered care, little is known about the delivery and documentation of serious illness conversations (SIC) for patients with cancer admitted on general internal medicine (GIM) wards.
objectivesTo characterize the documentation and experiences of SIC from the perspectives of patients and clinicians on GIM wards.
methodsThis mixed methods quality improvement project gathered data from GIM wards using a: (1) retrospective review of electronic medical record data of hospitalized patients with cancer, (2) survey of physicians, residents, nurses, and allied health clinicians regarding their clinical practice, and (3) semi-structured interviews with hospitalized patients/caregivers.
resultsThe charts of 101 patients were reviewed: 85.2% had a documented code status, while less than half (46.5%) had documentation of a conversation with a clinician addressing hopes, concerns or values. Ninety-seven clinicians completed the survey and reported variable levels of documentation of SICs. Clinician-identified barriers to serious illness conversations included language barriers, prognostic uncertainty, and lack of time. The 21 patients/caregivers who were interviewed reported a lack of focus on values in their discussions with clinicians, and a desire for their clinician to tailor these discussions to their individual needs.
conclusionIn patients with cancer admitted to GIM wards, code status was frequently documented, whereas values-based components of these SICs were less frequently recorded Our results represent an opportunity to improve both the delivery and documentation of more holistic, person-centered aspects of serious illness conversations as a means to drive goal-concordant care through targeted clinical and educational interventions.
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