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J Pain Symptom Manage. 2020 Mar 19. pii: S0885-3924(20)30136-6. doi: 10.1016/j.jpainsymman.2020.03.008. [Epub ahead of print]

Scaling implementation of the Serious Illness Care Program through Coaching.

Author information

1
Division of Palliative Care and Geriatrics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. Electronic address: calexandercole@mgh.harvard.edu.
2
Division of Palliative Care and Geriatrics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
3
Center for Psychiatric Oncology and Behavioral Sciences, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.

Abstract

BACKGROUND:

We designed group coaching calls to reinforce communication skill acquisition and Serious Illness Care Program (SICP) uptake in adult primary care.

MEASURES:

Percentage of primary care physicians who have documented a Serious Illness Conversation in the electronic health record (EHR) approximately 3 and 6 months after the coaching intervention. Participant feedback surveys to better understand provider attitudes toward the coaching intervention.

INTERVENTION:

We offered 60-minute group coaching calls to internal medicine primary care physicians, previously trained in serious illness conversation skills, as part of an institutional quality incentive program. The calls addressed communication challenges common to serious illness care and instructed participants about how to document and bill for conversations.

OUTCOMES:

We completed 31 coaching calls over three months in which 170 of 228 primary care physicians attended in groups of 2-9 participants per call (74.6% penetration rate). The percentage of primary care physicians who documented at least one Serious Illness Conversation in the electronic health record increased from 18.4% to 41.2% six months after the intervention. Primary care internal medicine physicians found the one-hour coaching calls to be highly valuable, with 86.9% of respondents attesting they would recommend the calls to their colleagues. Content analysis of participant feedback identified the most useful coaching content elements to be self-reflection around the impact of prior conversation skills training, instruction around using the EHR to find and document ACP discussions, the opportunity to share individual challenges and successes with peers, and feedback/advice from communication experts in palliative care.

CONCLUSIONS/LESSONS LEARNED:

Group coaching of primary care physicians resulted in more than a two-fold increase in documented serious illness conversations.

KEYWORDS:

advance care planning; coaching; communication; primary care; primary palliative care; serious illness

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