The Serious Illness Care Program: Implementing a Key Element of High-Quality Oncology Care

SummaryPatients with cancer often experience physical and psychosocial distress and receive care that is unwanted or unwarranted, especially near the end of life. Serious illness conversations (SICs) — person-centered conversations about patients’ prognosis, values, and goals to inform treatment and care planning — are a key element of high-quality oncology care and decrease patient distress. Penn Medicine, a large academic health center, and the Abramson Cancer Center sought to address low rates of documented conversations by implementing the Serious Illness Care Program, an evidence-based care delivery innovation that includes communication tools, clinician training, and system changes. SIC reminders were targeted toward patients at high risk for 180-day mortality. The intervention led to a sustained quadrupling of rates of conversations and no negative impact on the quality of those conversations. In addition, the program was associated with decreases in aggressive end-of-life care, including chemotherapy in the last days of life. Penn Medicine’s experience describes how a structured program, along with senior leadership and a communication guide, can transform serious illness communication at a large academic health system.