Serious illness conversations between doctors and patients happen far less often than they should, according to a new study. These discussions are critical for understanding patients' goals of care and avoiding unnecessary toxic treatments, yet they remain rare. Researchers tested simple nudges to increase their frequency.
Study details and findings
The study, which focused on oncologists and patients with poor prognoses, tested four approaches: mailing a letter to the patient encouraging them to think about advance care planning, emailing the oncologist before the appointment to suggest a conversation, both nudges, or no nudge (control group). The researchers then looked for documentation of a serious illness conversation in two places: the dedicated advance care planning section of medical records and the entire medical record via an AI algorithm.
In the dedicated section, only 10% of patients in the control group and those with a patient nudge had a documented conversation. This rose to 16% with a clinician nudge and 17% with both nudges. When scanning the entire medical record, 22% of controls and patient-nudged patients had documentation, compared to 28% with clinician nudge and 32% with both nudges.
Key takeaways
First, serious illness conversations are not happening nearly enough. This failure costs patients and society dearly. When they do occur, they are often not properly documented, leaving emergency professionals without crucial information. Second, telling patients to have these conversations does not work; reminding doctors is effective, and reminding both simultaneously is even better.
Ranjana Srivastava, an Australian oncologist and author, writes that holistic care for incurably ill patients must include discussions about death and dying. She notes that patients may not be ready, but often doctors are the barrier. 'Serious illness conversations don't happen anywhere near as often as warranted,' she writes.
Barriers and solutions
Immediate barriers for clinicians include lack of communications training, time constraints, and burnout. Srivastava emphasizes that change is possible with insight into why these conversations matter and how they save healthcare dollars, as well as foresight to build better systems.
She recounts a personal experience with a long-term cancer patient, where she gently raised the need to plan for worsening health. The patient responded with gratitude, saying, 'Thank you, I needed to hear that.'
