The Impact of Interventions on Serious Illness Conversations
Key Takeaways:
- In a study containing 1051 patients with projected poor health outcomes, researchers assessed the impact of intervention strategies on rates of serious illness conversations (SICs).
- Patients were randomly categorized into 1 of 4 groups: no intervention, patient intervention, clinical intervention, and combined intervention.
- The study’s findings illustrate that intervention, particularly clinician-based strategies, increased rates of SICs among patients.
For patients with aggressive diseases and poor prognoses, SICs could help improve quality of life and reduce health care utilization. However, their suboptimal occurrence highlights the need for regular interventions.
Study Methods and Outcomes
Researchers conducted a study that assessed the impact of patient and clinician reminders on rates of SICs. The trial included 1051 patients across 5 oncology clinics who had received a poor disease prognosis within 6 months and did not have a documented SIC.
Patients were randomly assigned to 1 of 4 cohorts:
- Patient intervention: patients received a letter and SIC questionnaire
- Clinician intervention: clinicians received an SIC email reminder the day before a medical visit
- Combined intervention: both strategies
- Control: no intervention
Outcomes included rates of SICs within 60 days and SICs identified in clinician notes using natural language processing (NLP).
The Impact of Intervention Strategies on SIC Occurrence
Among the 1051 patients included in the study, 261 had no intervention (control group), 240 were in the clinician intervention group, 273 made up the patient intervention group, and 277 received both interventions.
Rates of SIC were 10.7% for control, 16.7% for clinician intervention, 10.6% for patient intervention, and 17.3% for the combination cohort. NLP-SICs had higher occurrences, with rates of 22.6%, 28.8%, 22.3%, and 32.5%, respectively.
Patients in the combination cohort had significantly more SICs than those in the control group. Clinician intervention was associated with slightly higher rates of SICs. The patient intervention cohort had similar rates of SICs to the control group.
Implications for Oncology Care
The study demonstrated how SIC intervention, mainly through clinician reminders, could improve rates of SICs among patients with serious disease. Future research is needed to develop more effective strategies pertaining to consistent SIC occurrences.
According to the authors, “NLP increased detection of SICs, demonstrating the importance of evaluating SICs in free-text notes.”
Reference
Manz CR, Cotner CE, Tramontano AC, et al. Pathways to advance targeted and helpful serious illness conversations (PATH-SIC): a randomized clinical trial. J Natl Compr Cancer Netw. 2026;24(6):237-243. doi: 10.6004/jnccn.2025.7479
