Hostname: page-component-857557d7f7-bkbbk Total loading time: 0 Render date: 2025-11-28T17:46:58.521Z Has data issue: false hasContentIssue false
  • English
  • Français

Adapting the serious illness conversation guide for use in the emergency department by social workers

Published online by Cambridge University Press:  18 June 2021

Emily Loving Aaronson Open the ORCID record for Emily Loving Aaronson [Opens in a new window] ,
Jeffrey L. Greenwald ,
Lindsey R. Krenzel ,
Angelina M. Rogers ,
Lauren LaPointe  and
Juliet C. Jacobsen
Emily Loving Aaronson*
Affiliation:
Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA Lawrence Center for Quality and Safety, Massachusetts General Hospital and Massachusetts General Physicians’ Organization, Boston, MA
Jeffrey L. Greenwald
Affiliation:
Core Educator Faculty, Department of Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
Lindsey R. Krenzel
Affiliation:
Department of Social Work, Massachusetts General Hospital, Harvard Medical School, Boston, MA
Angelina M. Rogers
Affiliation:
Department of Social Work, Massachusetts General Hospital, Harvard Medical School, Boston, MA
Lauren LaPointe
Affiliation:
Department of Social Work, Massachusetts General Hospital, Harvard Medical School, Boston, MA
Juliet C. Jacobsen
Affiliation:
Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
*
Author for correspondence: Emily L. Aaronson, Lawrence Center for Quality and Safety, Massachusetts General Hospital, 55 Fruit St, Bulfinch Building, Suite 280, Boston, MA 02115, USA. E-mail: emily.aaronson@mgh.harvard.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

Although important treatment decisions are made in the Emergency Department (ED), conversations about patients’ goals and values and priorities often do not occur. There is a critical need to improve the frequency of these conversations, so that ED providers can align treatment plans with these goals, values, and priorities. The Serious Illness Conversation Guide has been used in other care settings and has been demonstrated to improve the frequency, quality, and timing of conversations, but it has not been used in the ED setting. Additionally, ED social workers, although integrated into hospital and home-based palliative care, have not been engaged in programs to advance serious illness conversations in the ED. We set out to adapt the Serious Illness Conversation Guide for use in the ED by social workers.

Methods

We undertook a four-phase process for the adaptation of the Serious Illness Conversation Guide for use in the ED by social workers. This included simulated testing exercises, pilot testing, and deployment with patients in the ED.

Results

During each phase of the Guide's adaptation, changes were made to reflect both the environment of care (ED) and the clinicians (social workers) that would be using the Guide. A final guide is presented.

Significance of results

This report presents an adapted Serious Illness Conversation Guide for use in the ED by social workers. This Guide may provide a tool that can be used to increase the frequency and quality of serious illness conversations in the ED.

Keywords

Emergency medicineGoals of carePalliative carePatient care planningSocial work

Information

Type
Original Article
Information
Palliative & Supportive Care , Volume 19 , Issue 6 , December 2021 , pp. 681 - 685
Check for updates
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

REFERENCES

Ariadne Labs: Serious Illness Program. (2019). https://www.ariadnelabs.org/areas-of-work/serious-illness-care/ (accessed January 2019).Google Scholar
Bernacki, RE and Block, SD (2014) Communication about serious illness care goals: A review and synthesis of best practices. JAMA Internal Medicine. doi:10.1001/jamainternmed.2014.5271CrossRefGoogle Scholar
Bernacki, R, Hutchings, M, Vick, J, et al. (2015a) Development of the serious illness care program: A randomised controlled trial of a palliative care communication intervention. BMJ Open. doi:10.1136/bmjopen-2015-009032CrossRefGoogle Scholar
Bernacki, R, Paladino, J, Lamas, D, et al. (2015b) Delivering more, earlier, and better goals-of-care conversations to seriously ill oncology patients. Journal of Clinical Oncology. doi:10.1200/jco.2015.33.29_suppl.39CrossRefGoogle Scholar
Bernacki, R, Paladino, J, Neville, BA, et al. (2019) Effect of the serious illness care program in outpatient oncology. JAMA Internal Medicine. doi:10.1001/jamainternmed.2019.0077CrossRefGoogle ScholarPubMed
Bosma, H, Johnston, M, Cadell, S, et al. (2010) Creating social work competencies for practice in hospice palliative care. Palliative Medicine. doi:10.1177/0269216309346596CrossRefGoogle ScholarPubMed
Cauley, CE, Block, SD, Koritsanszky, LA, et al. (2016) Surgeons’ perspectives on avoiding nonbeneficial treatments in seriously ill older patients with surgical emergencies: A qualitative study. Journal of Palliative Medicine. doi:10.1089/jpm.2015.0450CrossRefGoogle ScholarPubMed
Cicely Saunders, D (2001) Social work and palliative care—The early history. The British Journal of Social Work 31(5), 791–799.CrossRefGoogle Scholar
Cooper, Z, Koritsanszky, LA, Cauley, CE, et al. (2016) Recommendations for best communication practices to facilitate goal-concordant care for seriously ill older patients with emergency surgical conditions. Annals of Surgery. doi:10.1097/SLA.0000000000001491CrossRefGoogle ScholarPubMed
DeVader, TE, Albrecht, R and Reiter, M (2011) Initiating palliative care in the emergency department. The Journal of Emergency Medicine 43(5), 803–810. doi:10.1016/j.jemermed.2010.11.035CrossRefGoogle ScholarPubMed
Gace, D, Sommer, RK, Daubman, BR, et al. (2020) Exploring patients’ experience with clinicians who recognize their unmet palliative needs: An inpatient study. Journal of Palliative Medicine. doi:10.1089/jpm.2020.0043CrossRefGoogle Scholar
Grudzen, CR, Richardson, LD, Johnson, PN, et al. (2016) Emergency department-initiated palliative care in advanced cancer a randomized clinical trial. JAMA Oncology 2(5), 591–598. doi:10.1001/jamaoncol.2015.5252CrossRefGoogle ScholarPubMed
Lakin, JR, Block, SD, Andrew Billings, J, et al. (2016) Improving communication about serious illness in primary care a review. JAMA Internal Medicine. doi:10.1001/jamainternmed.2016.3212CrossRefGoogle ScholarPubMed
Lakin, JR, Koritsanszky, LA, Cunningham, R, et al. (2017) A systematic intervention to improve serious illness communication in primary care. Health Affairs. doi:10.1377/hlthaff.2017.0219CrossRefGoogle ScholarPubMed
Lamas, DJ, Owens, RL, Nace, RN, et al. (2017a) Opening the door: The experience of chronic critical illness in a long-term acute care hospital. Critical Care Medicine. doi:10.1097/CCM.0000000000002094CrossRefGoogle Scholar
Lamas, DJ, Owens, RL, Nace, RN, et al. (2017b) Conversations about goals and values are feasible and acceptable in long-term acute care hospitals: A pilot study. Journal of Palliative Medicine. doi:10.1089/jpm.2016.0485CrossRefGoogle Scholar
Lamba, S, DeSandre, PL, Todd, KH, et al. (2014) Integration of palliative care into emergency medicine: The improving palliative care in emergency medicine (IPAL-EM) collaboration. The Journal of Emergency Medicine 46(2), 264–270. doi:10.1016/j.jemermed.2013.08.087CrossRefGoogle Scholar
Mandel, EI, Bernacki, RE and Block, SD (2017) Serious illness conversations in ESRD. Clinical Journal of the American Society of Nephrology. doi:10.2215/CJN.05760516CrossRefGoogle ScholarPubMed
Paladino, J, Bernacki, R, Neville, BA, et al. (2019) Evaluating an intervention to improve communication between oncology clinicians and patients with life-limiting cancer: A cluster randomized clinical trial of the serious illness care program. JAMA Oncology. doi:10.1001/jamaoncol.2019.0292CrossRefGoogle ScholarPubMed
Rosenberg, LB, Greenwald, J, Caponi, B, et al. (2017) Confidence with and barriers to serious illness communication: A national survey of hospitalists. Journal of Palliative Medicine. doi:10.1089/jpm.2016.0515CrossRefGoogle ScholarPubMed
Wu, FM, Newman, JM, Lasher, A, et al. (2013) Effects of initiating palliative care consultation in the emergency department on inpatient length of stay. Journal of Palliative Medicine 16(11), 1362–1367. doi:10.1089/jpm.2012.0352CrossRefGoogle ScholarPubMed