Serious Illness Care Programme UK: Assessing the ‘face validity’ and acceptability of the Serious Illness Conversation Guide (SICG) for use within the UK health care setting.


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Tamsin McGlinchey1,Stephen Mason1,Alison Coackley2,Maria Maguire2,Francine Maloney3,Justine Sanders3,Joanna Paladino3,Susan Block3,Peter Kirkbride2,John E Ellershaw1
1Marie Curie Palliative Care Institute Liverpool, University of Liverpool,2Clatterbridge Cancer Centre NHS Foundation Trust,3Ariadne Labs

Abstract

Background

The Serious Illness Care Programme (SICP) is a complex intervention developed in the US by Atul Gwande’s ARIADNE Labs to improve communication between clinicians and patients with advanced cancer. The Serious Illness Conversation Guide (SICG) is an evidence-based clinical tool to guide clinical conversations. NHS England have funded a pilot implementation of  the  SICP within the UK (SICP-UK).  Prior to the  pilot, a project was undertaken to assess  the appropriateness of the SICG for a UK context.

Method

This study utilised a mixed methods approach to gain the views of clinicians and patient and public representatives:

Nominal Group Technique with 3 ‘expert’ groups; 5 Oncologists, 5 Communication Skills experts, 4 Palliative Care specialists:

  • Review SICG; make recommendations for improvements;
  • Reach consensus; could SICG be used in the UK?

Cognitive Interview Technique; 6 patient and public representatives:

  • Understand how respondents perceive and interpret prompts in the SICG;
  • Assess format, context and language.

Results

Nominal Group Technique:

  • Consensus gained: SICG could provide support for clinicians to improve communication with patients and their families.
  • One major recommendation:
    • Remove phrase “we’re in this together” as not suitable for UK context.

Congnitive Interviews:

  • Overall concept of SICG valued; beneficial for clinicians and patients, promoting a ‘partnership’ approach to care planning;
  • Some wording/phrases too ‘formal’: e.g. ‘goals’, ‘priorities and wishes’, ‘abilities’, ‘critical’;
  • Education and training identified as key; SICG should enable flexibility;
  • Phrase “we’re in this together” to be removed.

Conclusion

Participants felt the SICG would aid communication between clinicians and patients, and the approach was valued by all.  Small amendments were identified and a revised SICG for the UK was developed.

 An NHS England funded pilot is underway at three clinical sites. Research to investigate the acceptability and feasibility of the implementation of the SICP-UK is being undertaken.