Serious illness conversations … who’s having them?

Role clarity – understanding who does what when and how – is a known barrier when it comes to health care provider teams having earlier, better and more frequent serious illness conversations. A new pilot program for undergrads in nursing, social work, medicine and occupational therapy is helping to break down this barrier to the benefit of patients and their health care team.

Interprofessional approach

To help prepare future interprofessional clinicians with essential skills in delivering high quality serious illness care, BCCPC collaborated with the UBC Division of Palliative Care and Departments of Nursing, Social Work, Medicine and Occupational Therapy to offer a pilot interprofessional serious illness conversation workshop as a UBC Health Interprofessional Enrichment Activity. The pilot was the first of its kind in BC with an interprofessional approach to training undergraduates in the use of the serious illness conversation guide and how the serious illness conversation enhances person-centred care.

In addition to the initial interdisciplinary pilot of 32 students in November 2021, the workshop has been presented to undergrads in the departments of nursing at BCIT, UBC-O, UBC and UVic and the faculty of medicine at UBC. Over 1,200 undergraduates in both disciplines have received the training over the past few years, but not in a multidisciplinary setting. The pilot was designed to support a team approach to having serious illness conversations and reflect the reality of the clinical setting, using a virtual platform.

To help ensure the sustainability of the interprofessional education session, BCCPC offered a Train the Trainer session to train educators as facilitators to support this enrichment activity. The virtual interactive role play used in the sessions enhances practical skills and provides the opportunity of all health care disciplines to experience conducting a serious illness conversation in a safe learning environment.

Results and feedback

All the participants agreed that the workshop enhanced their knowledge about serious illness conversations and that they were motivated to incorporate what they had learned into their clinical practice. Many learners expressed that they found the wording in the guide and ways to address emotions very helpful.

Barriers to incorporating the guide into practice were identified as lack of confidence in having difficult conversations, role clarity within their teams, time, lack of knowledge related to prognosis, lack of experience and preparation. However, all agreed that with practice and more experience they would feel more confident and that they would recommend this training workshop to others. As one learner said, “I found this session to be so useful and applicable to practice”

Overall, the comments about the workshop were very positive. More time, more practice with different cases, more opportunity to debrief on how to deal with emotion, more focus on cultural sensitivity and how the questions could be divided amongst disciplines were some suggestions put forward for future workshops.

Our next steps will be to further discuss how the interprofessional Serious Illness Conversation Workshop can be incorporated into course curriculum to not only further a person-centred approach to care but to foster a team approach in supporting a person facing a serious illness and their loved ones.

For more information, contact Elizabeth Beddard-Huber at ebeddard-huber@bc-cpc.ca.

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