My Life My Choices Trains Serious Illness Conversation Instructors

Studies have shown that conversations where clinicians address goals of care for patients/families facing serious illness and end-of-life issues are either not held at all or are held too late in the process. Because of this, training Serious Illness Conversation Instructors is critical.

Currently, conversations that do take place are frequently of poor quality, focusing on treatments rather than what is most important to the patient. From this, several barriers to meaningful, quality goals of care conversations have been identified.

On the clinician side, barriers include lack of adequate training to have these conversations, lack of time to hold the conversation, uncertainty as to who should initiate the conversation, and concern regarding the patient’s readiness for the conversation.

An important system barrier that has been identified is the documentation and accessibility of goals of care discussions within the electronic medical record (EMR).

The My Life My Choices education model recognizes all of these barriers and has adopted the Serious Illness Conversation Program (SICP) introduced by Ariadne Labs in Boston to help mitigate several of them.

This program includes a structured skills-based 3-hour training course that teaches much-needed communication skills to clinicians.

The program focuses on the Serious Illness Conversation Guide, a structured communication guide that provides the clinician with language that elicits the patient’s understanding of their illness, as well as their treatment preferences based on personal values, goals, and beliefs.

Other important parts of the guide are the verbiage surrounding delivery of a prognosis and making recommendations to move forward that are based on patient preferences.

The SICP course includes a skills practice segment that requires an instructor to interface with no more than 3-4 learners at one time. This requirement made it quite evident that the initial eight SICP instructors trained in August 2018, by Justin Sanders and Joanna Paladino, of Ariadne Labs, would need help.

On February 22-23, 2019, another instructor course was held in Columbia in which 14 additional SICP instructors were trained by Wilma Rice, MSN, RN, CEN. Wilma serves as the Co-Chair (with Laura Cole) of the Education/Community Engagement Committee and as an Education Consultant for My Life My Choices.

This was just one of many similar events that will be held in the coming months.

The new instructors attended the intense two-day instructor course, learning to teach each component of the three-hour course. They learned how to lead the small group role-play exercise, one of the most important portions of the course. Role playing allows the clinician the opportunity to practice the much-needed communication skills in a safe, non-threatening environment.

The new instructors come from all disciplines: physicians, nurses, social workers, and chaplains. All attendees reported an increase in their knowledge and skills pertaining to ACP conversations through the course evaluations.

These SICP instructors have much to offer, and will play an important role in training clinicians across South Carolina to have person-centered, family-oriented serious illness conversations with their patients.