Tools for Trust Building: Developing a Serious Illness Conversation Primer

Key Message: Community-engaged research highlights the need for trust-building and personalized approaches to Serious Illness Communication (SIC). We developed a Serious Illness Conversation “Primer,” a clinical tool that emphasizes skills and language that interprofessional clinicians can use to better meet the needs of patients and families and equitably engage all in SIC.

Abstract:

Introduction: Serious illness communication (SIC) tools aim to guide clinicians in discussing values, priorities, and prognosis, but often overlook relational and cultural dynamics essential to high-quality communication for diverse patient populations.(1, 2) Patients from marginalized communities face systemic inequities and understandable mistrust affecting SIC engagement.(3, 4) Current tools provide frameworks but lack guidance on trust-building and “pre-work” to tailor conversations to individual context. Personalizing communication is essential in facilitating equitable, effective SIC.

Objective: We sought to develop a tool to support clinicians in preparing for SIC in ways that build trust and acknowledge identity, context, and lived experience.

Methods: We conducted a community-engaged, human-centered design process to develop the Serious Illness Conversation “Primer” (SIC Primer). An interprofessional team with expertise in health equity, serious illness communication, human-centered design methods, and clinical education developed the Primer prototype. To refine the prototype, we sought feedback from clinicians across disciplines and specialties, including hospital medicine, cardiology, hepatology, nephrology, critical care, neurology, emergency medicine, pediatrics, and palliative care, in our institution.

Results: We developed the SIC Primer, a comprehensive one-page tool outlining questions for clinicians to consider before and skills to employ during SIC. It consists of three domains: (A) self-reflection on bias and values that influence SIC (consider your biases, share values-neutral information), (B) learning and building trust before engaging in SIC (build rapport, assess communication preferences, explore prior experiences with SIC), and (C) applying trust-building techniques throughout conversations (ask permission, allow multiple opportunities for questions). The Primer has been integrated into synchronous and asynchronous SIC educational training that has reached >4,000 interprofessional clinicians in versions tailored for adult and pediatric patients.

Conclusion: The SICG Primer tool is well-suited to pair with health-system SIC educational and quality improvement initiatives and highlights that curricular improvements addressing diverse patient needs can enhance care for all.

References: 1. Davila C, Nouri S, Chan SH, et al. Perceptions of Patient-Clinician Communication Among Adults With and Without Serious Illness. JAMA Network Open. 2025;8(3):e250365-e.
2. Massachusetts Coalition for Serious Illness Care: 2020-2021 Public Experience Research Findings. Massachusetts Coalition for Serious Illness Care: Massachusetts Coalition for Serious Illness Care; 2021 [cited 2024 September 23]; Available from: https://www.maseriouscare.org/research-resources.
3. Fromme E, Paladino J, Hasan M, et al. Redesigning a Serious Illness Conversation Guide to Center Equity: A Community-Engaged Qualitative Process. Journal of pain and symptom management. 2024;67(5):e559-e60.
4. Ravicz M, Sullivan KA, Aranga JL, et al. Listening to Many Voices: Serious Illness Communication Preferences Among Black and Latino Patients. Journal of pain and symptom management. 2024;67(5):e528-e9.