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

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.

Translation, Adaptation, and Validation of the Swedish Serious Illness Conversation Guide

“…This dual approach can support patients and clinicians to reach common understandings 20 and allows for “big picture” serious illness conversations. 11 , 33 It also allows clinicians to explore patients’ illness understanding and discuss health and illness at a pace that aligns with patient preferences. 4 However, it is important to be aware that each patient has their own coping timeline and might not be ready or willing to discuss certain subjects, 34 thus the clinician can encourage but not impose the dual approach of hoping and preparing.…”

“…4 While the SICP and SICG were originally developed in English and tested in the American healthcare setting among oncology patients, it has since been adapted for diverse cultural 9,10 and clinical settings. [11][12][13][14] The SICG has been translated into thirteen languages 15 ; however, the processes by which these translations and cultural adaptations occurred, and the acceptability, applicability, and validity of the translated versions have yet to be explored.…”

Adapting the Serious Illness Conversation Guide for Unhoused Older Adults: A Rapid Qualitative Study

“…26 It is a tool designed to support professionals who lack serious illness communication training in having serious illness conversations and does not require extensive training or skills. The SICG was initially developed for nurse practitioners and physicians in oncology settings, 18 and has been adapted for various settings and populations that include emergency departments with social workers, 27 dementia care, 28 indigenous populations, 29 and telehealth delivery for older adults. 30 However, the guide has not yet been adapted to consider the needs of multiple professions in non-healthcare settings nor OAEH.…”

Supporting health and social care professionals in serious illness conversations: Development, validation, and preliminary evaluation of an educational booklet

“…Written conversation guides have been introduced in different clinical contexts, such as emergency departments, intensive care units, primary care, oncology, and long-term care to provide high-quality patient-centered care [12,21,22]. In these experiences, the original conversation guides were adapted to the care environment and the scope of practice of the healthcare professionals who would use the guide [23].…”