Feasibility of the SICP in one North West Cancer Centre
Research type
Research Study
Full title
Serious Illness Care Programme UK (SICP-UK): Assessing the feasibility of implementing the SICP-UK within one cancer centre in the North West of England.
IRAS ID
213686
Contact name
John Edward Elleshaw
Contact email
Sponsor organisation
RD&I Department, Royal Liverpool University Hospital
Duration of Study in the UK
0 years, 6 months, 26 days
Research summary
Research Summary
In order to deliver high quality healthcare that is effective, safe and ‘person centred', health care services must actively involve patients, and their families, in decisions about their care. In North America, the Serious Illness Care Programme (SICP) has been devised to improve communication between clinicians and adult patients with a serious illness, to ensure care provided is more ‘person centred’. The SICP combines education and training for clinicians in communication skills, and specifically in the implementation and use of a Serious Illness Conversation Guide (SICG).The SICG is a ‘conversation guide’ which prompts clinicians to address important issues with patients such as: illness understanding, information preferences, prognosis, goals and values, fears and worries, priorities for future health care, and family involvement. An NHS England funded pilot is being undertaken to transfer the SICP model of communication and care planning from the US to the UK setting (SICP-UK), and this research study forms part of that work.
The aim of this research is to assess the feasibility of the study methodology and to assess the perceived acceptability of the SICP-UK for patients and clinicians.
The overall outcomes of this study will be to:
- Provide data on the feasibility of the study methodology; findings from this study will influence potential larger studies, to directly assess the efficacy of the SICP-UK for improving outcomes for patients with serious illness.
- Assess whether the Serious Illness Care Programme (SICP-UK), including the education and training and use of the Serious Illness Conversation Guide (SICG), indicates benefit to patients within the UK health care setting.
Summary of Results
Poor communication about end-of-life issues contributes to a lack of shared decision-making and care planning, and can be detrimental to the quality of life of seriously ill patients and their families. However, such conversations can be challenging. For example, clinicians often miss or avoid opportunities for these discussions, and patients/families view professionals as being too busy to talk. The Serious Illness Care Programme is a ‘systems wide’ complex intervention to improve communication, care planning and quality of life for patients with serious illness (SI). A pilot implementation project of the Serious Illness Care Programme in the UK reported positive preliminary results and recommended further research into the experiences of key ‘actors’ in these conversations.Aim:
Conduct a qualitative exploration of the lived experience of seriously ill patients and clinicians who have engaged in SI conversations.Method:
A phenomenological approach was taken, using one-to-one narrative style interviews with two participant groups: (1) patients with cancer, and patients with renal failure receiving dialysis, with experience of the SI conversation; (2) oncology and nephrology consultants who facilitated the SI conversations. Reflexive Thematic Analysis was used to identify patterns of meaning related to the experience of engaging in these conversations.Results:
Three themes were generated from patient and clinician interviews:
Firstly, patient and clinician narratives show the Serious Illness Conversation manifests as a ‘different conversation’ to those engaged in usual clinic appointments, which led to different information being shared, opening up more and different conversations; secondly, patient narratives showed how, despite the emotional load, the ‘Serious Illness Conversations are a transformative experience’, bringing about observable ‘gains’ for patients; thirdly, ‘Systems, Structure, Process: Serious Illness Conversations, epistemic injustice and cultural violence’ draws on clinician narratives to highlight the influence of organisational culture, systems and processes, on the way that Serious Illness Conversations were engaged and experienced.Conclusion:
Both clinicians and patients benefitted from the opportunity to engage in Serious Illness Conversations, but organisational constraints due to inflexible systems and structures within the hospital organisation restricted, inhibited, or prohibited these conversations, placing the conversations ‘outside’ routine practice. There is a need to ‘normalise’ these conversations as part of routine practice and ensure that an organisational infrastructure is developed to facilitate these conversations.REC name
Wales REC 4
REC reference
16/WA/0276
Date of REC Opinion
9 Sep 2016
REC opinion
Favourable Opinion