Family Medicine, The University of Iowa, 200 Hawkins Drive, Iowa, USA.
J Palliat Care. 2022 Jul;37(3):332-340. doi: 10.1177/08258597221090387. Epub 2022 Mar 28.
The Serious Illness Care Program (SICP), developed in 2011 by Ariadne Labs, restructures care so that knowing and then honoring patients' wishes becomes part of routine care. 1) summarize patient perceptions of use of the Serious Illness Conversation Guide (SICG) components, 2) assess whether a serious illness conversation was documented in the electronic health record (EHR) and identify the SICG components that were included, 3) summarize clinician perceptions of use of the SICG components, and 4) assess the association of documented SICG components with the patient's perception of the SICG discussion. Clinicians at three family medicine offices were trained in serious illness conversations using the SICG. They documented their serious illness conversations in the medical record. Retrospective chart review for SICG components was conducted for patients. Patients and clinicians completed questionnaires about their experience with the SICG. Statistical analysis included the Pearson chi-square test for categorical variables and Cohen's kappa to determine agreement between clinician documentation and patient perception. Eighty-nine patients consented and completed their baseline questionnaire. Mean age of the 89 patients was 72 years and 65 (73%) were female. Thirty (34%) medical records had one or more SICG components documented. Seventy-nine (89%) patients reported at least one individual component of the SICG being discussed. Clinicians reported they engaged in asking patients what is important to them at a mean of 5.9, with 7 being "all the time". There was slight agreement (kappa = .19) for patient perception and clinician documentation of discussing patient goals, but no agreement for any of the other SICG components. Even among trained clinicians, only one-third of patients had documentation of at least one SICG component. Only slight agreement was found between clinician documentation of SICG in the medical record and patient perception of SICG discussion.
严重疾病照护计划（SICP）由 Ariadne Labs 于 2011 年开发，它重新调整了照护方式，使了解并尊重患者的意愿成为常规照护的一部分。1）总结患者对使用严重疾病对话指南（SICG）各组成部分的看法，2）评估电子健康记录（EHR）中是否记录了严重疾病对话，并确定所包含的 SICG 组成部分，3）总结临床医生对 SICG 组成部分的使用看法，以及 4）评估记录的 SICG 组成部分与患者对 SICG 讨论的看法之间的关联。三家家庭医学办公室的临床医生接受了使用 SICG 进行严重疾病对话的培训。他们在病历中记录了他们的严重疾病对话。对患者的 SICG 组成部分进行了回顾性图表审查。患者和临床医生完成了关于他们使用 SICG 的经验的问卷。统计分析包括卡方检验用于分类变量和 Cohen 的 kappa 来确定临床医生记录和患者感知之间的一致性。89 名患者同意并完成了他们的基线问卷。89 名患者的平均年龄为 72 岁，其中 65 名（73%）为女性。30 份（34%）病历记录了一个或多个 SICG 组成部分。79 名（89%）患者报告至少讨论了 SICG 的一个单独组成部分。临床医生报告说，他们平均以 5.9 的频率询问患者对他们来说重要的事情，其中 7 是“一直”。在讨论患者目标方面，患者感知和临床医生记录之间存在轻微的一致性（kappa=0.19），但对于任何其他 SICG 组成部分都没有一致性。即使是在经过培训的临床医生中，也只有三分之一的患者有记录至少一个 SICG 组成部分。在临床医生在病历中记录 SICG 与患者对 SICG 讨论的感知之间仅发现轻微的一致性。
