Practicing Serious Illness Conversations in Graduate Medical Education.

BACKGROUND

Physician trainees are not provided with routine practice opportunities to have a serious illness conversation, which includes a discussion of patient expectations, concerns, and preferences regarding an advancing illness.

OBJECTIVE

To test the acceptability of incorporating a serious illness conversation into routine trainee practice.

METHODS

Residents in an internal medicine program conducted a serious illness conversation in the ambulatory care setting with the assistance of a conversation guide. Semi-structured interviews determined trainees' perceptions of the educational intervention. Patients were surveyed to understand their experience.

RESULTS

Twenty-one trainees had at least one opportunity to practice having a serious illness conversation and completed a majority of the conversation elements. In semi-structured interviews, trainees expressed the belief that the serious illness conversation should be an important component of routine patient care, understood that patients are willing to have these conversations, discovered that patients did not have a clear understanding of their prognosis, and said that time is the main barrier to having these conversations more consistently. Patients found the conversation to be important (92%), reassuring (83%), and of higher quality than the communication of a usual doctor visit (83%).

CONCLUSIONS

With preparation, time, and a conversation guide, trainees completed the elements of a serious illness conversation and found it to be an important addition to their routine practice. Patients found the conversation to be important, reassuring, and of better quality than their usual visits.