Discussing What Matters Most

Feb 28, 2022

Practice pointer featured in the BMJ about eliciting patients’ goals and preferences to improve the quality of care for those with serious illnesses.

Read More in the BMJ

Discussing What Matters Most

Feb 28, 2022

Practice pointer featured in the BMJ about eliciting patients’ goals and preferences to improve the quality of care for those with serious illnesses.

Read More in the BMJ

Serious illness refers to health conditions that have a high risk of mortality and negatively affect a person’s daily functioning or quality of life. Life prolonging treatments may not align with the preferences or goals and increase suffering for those living with serious illness and their family members or caregivers.

A growing body of evidence and Choosing Wisely recommendations highlight the importance of integrating serious illness conversations as a standard component of care. These conversations are intended to increase the patient’s understanding of their condition and elicit goals and preferences before making treatment decisions. Evidence suggests that serious illness conversations can help patients receive the care they want, feel less distress, and avoid treatments that may cause harm.

What are the barriers to having these conversations?
Insufficient communications training, time constraints, and uncertainty about the progression of the illness are some of the barriers to integrating serious illness conversations into practice.

How should practice change?
Dr. Justin Sanders and an international group of clinician and patient coauthors suggest using a structured, evidence-based communication tool to start these conversations. The Serious Illness Conversation Guide can help determine what matters most to those with serious illnesses, including their preferences and goals of care. The authors also highlight that health systems adopt systemic approaches to better integrate serious illness conversations as a standard component of care.