Making Serious Illness Conversations Happen: Understanding Implementation Through Teamwork

Key Message : Interprofessional teamwork enhances the reliability and quality of serious illness conversations when teams share responsibility and accountability, collaborate across roles, and receive leadership and structural support for their roles. Fostering an inclusive team culture is an essential ingredient to overcoming hierarchy-related barriers and to sustaining person-centered SIC across clinical settings.

Abstract:

Introduction: Teamwork is essential for the reliable delivery of serious illness conversations (SIC) in routine care.(1-3) Although recent studies highlight the importance of interprofessional involvement and training, limited evidence describes the factors that facilitate or inhibit effective teamwork in implementing SIC across health systems.

Objective: Examine facilitators and barriers to inter-professional teamwork as part of SIC improvement initiatives in five health systems that implemented the Serious Illness Care Program.

Methods: We conducted a secondary qualitative analysis(4) of de-identified interview transcripts from a parent study(5) describing implementation strategies for SIC. Using content analysis, we reanalyzed data from 30 interprofessional leaders exploring interprofessional teamwork in SIC. A multidisciplinary team applied inductive coding, creating categories and themes.

Results: Participants included n= 18 physicians; n=4 registered nurses and social workers; n=3 advanced practice providers (APPs); and n= 5 project managers in palliative care, oncology, hospital medicine, and primary care. We identified two themes that facilitate teamwork: 1) fostering a culture of team responsibility and accountability; 2) team collaboration before, during, and after SICs. The first theme reflects how leadership support, physician allies, and structured workflows facilitated interprofessional empowerment, involvement, and collaboration in serious illness conversations. The second theme embodies how specific team members, especially nurses and social workers, collaborated with their physician and APP colleagues, with patients or caregivers, and with specialists to prepare for conversations in advance, to support conversations in the moment, and to implement care plans after conversations. Barriers included lack of respect for non-physician roles, uncertainty about scope of practice, and discomfort sharing patient goals that conflicted with treatment plans.

Conclusion: A culture of shared responsibility, leadership support, and clear workflows enables teams to deliver SIC. Strengthening team-based SIC requires moving beyond skills training toward interprofessional team development and system-level strategies that promote inclusion, mutual respect, and shared accountability.

References: 1. Myrhøj CB, Viftrup DT, Jarden M, Clemmensen SN. Interdisciplinary collaboration in serious illness conversations in patients with multiple myeloma and caregivers–a qualitative study. BMC palliative care. 2023 Jul 13;22(1):93.
2. Paladino J, Brannen E, Benotti E, et al. Implementing Serious Illness Communication Processes in Primary Care: A Qualitative Study. American Journal of Hospice and Palliative Medicine®. 2021;38(5):459-466.
3. Lakin JR, Benotti E, Paladino J, et al. Interprofessional Work in Serious Illness Communication in Primary Care: A Qualitative Study. J Palliat Med. 2019;22(7):751-763.
4. Thorne S. Secondary qualitative data analysis. Routledge international handbook of qualitative nursing research: Routledge 2013:393-404.
5. Paladino J, Sanders JJ, Fromme EK, et al. Improving serious illness communication: a qualitative study of clinical culture. BMC palliative care. 2023;22(1):104.