Core Competencies for Serious Illness Conversations: An Integrative Systematic Review.

Publisher: SAGE Country of Publication: United States NLM ID: 8610345 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2369-5293 (Electronic) Linking ISSN: 08258597 NLM ISO Abbreviation: J Palliat Care Subsets: MEDLINE

Publication: 2017- : Thousand Oaks, CA : SAGE
Original Publication: Toronto, Ont. : [University of Toronto Press, c1985-

Clinical Competence*/standards ; Communication* ; Physician-Patient Relations*; Humans ; Critical Illness/psychology

Objective: The Serious Illness Care Program was developed to support goals and values discussions between seriously ill patients and their clinicians. The core competencies , that is, the essential clinical conversation skills that are described as requisite for effective serious illness conversations (SICs) in practice, have not yet been explicated. This integrative systematic review aimed to identify core competencies for SICs in the context of the Serious Illness Care Program. Methods: Articles published between January 2014 and March 2023 were identified in MEDLINE, PsycINFO, CINAHL, and PubMed databases. In total, 313 records underwent title and abstract screening, and 96 full-text articles were assessed for eligibility. The articles were critically appraised using the Joanna Briggs Institute Critical Appraisal Guidelines, and data were analyzed using thematic synthesis. Results: In total, 53 articles were included. Clinicians' core competencies for SICs were described in 3 themes: conversation resources, intrapersonal capabilities, and interpersonal capabilities. Conversation resources included using the conversation guide as a tool, together with applying appropriate communication skills to support better communication. Intrapersonal capabilities included calibrating one's own attitudes and mindset as well as confidence and self-assurance to engage in SICs. Interpersonal capabilities focused on the clinician's ability to interact with patients and family members to foster a mutually trusting relationship, including empathetic communication with attention and adherence to patient and family members views, goals, needs, and preferences. Conclusions: Clinicians need to efficiently combine conversation resources with intrapersonal and interpersonal skills to successfully conduct and interact in SICs.
Competing Interests: Declaration of Conflicting InterestsSeveral authors (SA, AS, JP, and EKF) authored articles that were reviewed in this study. These authors were not involved in the article selection, data extraction or quality appraisal processes. EKF and JP are faculty in Ariadne Labs’ Serious Illness Care Program.

Palliat Support Care. 2023 Oct;21(5):788-797. (PMID: 36184937)
Cancer. 2021 Nov 15;127(22):4258-4265. (PMID: 34351620)
Prim Care. 2019 Sep;46(3):353-372. (PMID: 31375186)
Curr Oncol. 2022 Mar 02;29(3):1527-1536. (PMID: 35323328)
BMC Med Res Methodol. 2008 Jul 10;8:45. (PMID: 18616818)
Blood Adv. 2023 May 9;7(9):1871-1884. (PMID: 36521100)
Palliat Med Rep. 2020 Nov 24;1(1):280-290. (PMID: 34223487)
J Palliat Med. 2020 Mar;23(3):337-345. (PMID: 31503520)
BMC Palliat Care. 2020 Nov 2;19(1):168. (PMID: 33138799)
Oncologist. 2020 Mar;25(3):e578-e588. (PMID: 32162796)
J Gen Intern Med. 2022 Jan;37(1):130-136. (PMID: 34327652)
Ann Emerg Med. 2020 Dec;76(6):751-756. (PMID: 32747084)
Int J Environ Res Public Health. 2022 Mar 31;19(7):. (PMID: 35409844)
Patient Educ Couns. 2021 May;104(5):1237-1245. (PMID: 33234440)
J Palliat Care. 2024 Jan;39(1):13-20. (PMID: 36721382)
BMJ Support Palliat Care. 2022 Feb 15;:. (PMID: 35168931)
Palliat Med Rep. 2020 Jul 28;1(1):135-142. (PMID: 34223467)
J Pain Symptom Manage. 2023 Oct;66(4):351-360.e1. (PMID: 37433418)
Am J Hosp Palliat Care. 2021 May;38(5):459-466. (PMID: 32794412)
Patient Educ Couns. 2009 Mar;74(3):295-301. (PMID: 19150199)
BMJ Open. 2015 Oct 06;5(10):e009032. (PMID: 26443662)
BMJ. 2021 Mar 29;372:n71. (PMID: 33782057)
J Pain Symptom Manage. 2022 Feb;63(2):e252-e259. (PMID: 34743012)
J Palliat Med. 2022 Nov;25(11):1708-1714. (PMID: 36036825)
JAMA. 2022 Jan 25;327(4):321-322. (PMID: 34994773)
J Palliat Care. 2024 Jan;39(1):21-28. (PMID: 37886797)
Can Fam Physician. 2020 Jul;66(7):533-536. (PMID: 32675100)
Med Clin North Am. 2020 May;104(3):375-389. (PMID: 32312404)
Healthc (Amst). 2021 Jun;9(2):100510. (PMID: 33517037)
J Gen Intern Med. 2016 Jul;31(7):755-61. (PMID: 26921153)
J Palliat Med. 2021 Jan;24(1):53-62. (PMID: 32580676)
J Palliat Med. 2020 Nov;23(11):1493-1499. (PMID: 32368957)
PLoS One. 2019 Aug 22;14(8):e0221412. (PMID: 31437225)
BMJ Support Palliat Care. 2021 Mar 17;:. (PMID: 33731464)
J Palliat Med. 2020 Jan;23(1):112-115. (PMID: 31081710)
BMC Health Serv Res. 2019 Jun 13;19(1):384. (PMID: 31196072)
J Palliat Med. 2019 Jul;22(7):773-781. (PMID: 30724693)
JCO Oncol Pract. 2020 Dec;16(12):e1507-e1515. (PMID: 32749931)
Am J Hosp Palliat Care. 2018 May;35(5):804-811. (PMID: 29121789)
JAMA Intern Med. 2019 Jun 1;179(6):751-759. (PMID: 30870563)
Jt Comm J Qual Patient Saf. 2021 Feb;47(2):127-136. (PMID: 33191165)
J Gen Intern Med. 2021 Apr;36(4):1094-1097. (PMID: 33501542)
Am J Hosp Palliat Care. 2019 Dec;36(12):1096-1104. (PMID: 31327241)
BMC Palliat Care. 2022 Jun 29;21(1):116. (PMID: 35764991)
JAMA Oncol. 2019 Jun 01;5(6):801-809. (PMID: 30870556)
J Palliat Care. 2022 Jul;37(3):332-340. (PMID: 35341365)
J Hosp Palliat Nurs. 2019 Aug;21(4):291-299. (PMID: 30893288)
J Pediatr. 2021 Feb;229:247-258.e8. (PMID: 32949579)
J Pain Symptom Manage. 2016 Jan;51(1):1-8. (PMID: 26297851)
Nurse Educ. 2023 Jul-Aug 01;48(4):209-213. (PMID: 36749963)
J Palliat Med. 2018 Mar;21(S2):S17-S27. (PMID: 29091522)
BMJ Support Palliat Care. 2024 Feb 13;:. (PMID: 37369576)
CMAJ Open. 2020 Jun 19;8(2):E448-E454. (PMID: 32561591)
ATS Sch. 2020 Mar 18;1(2):119-133. (PMID: 33870276)
J Hosp Palliat Nurs. 2021 Feb 1;23(1):38-45. (PMID: 33136801)
J Pain Symptom Manage. 2023 Jun;65(6):521-531. (PMID: 36764413)
PLoS One. 2015 Dec 02;10(12):e0143703. (PMID: 26630180)
J Cancer Educ. 2021 Dec;36(6):1325-1332. (PMID: 32504362)
Cancer Med. 2020 Jul;9(13):4550-4560. (PMID: 32363775)
BMC Med Educ. 2022 Jan 30;22(1):71. (PMID: 35093060)
Eur J Cancer Care (Engl). 2022 Jan;31(1):e13537. (PMID: 34734446)
Nurs Ethics. 2021 Sep;28(6):1010-1025. (PMID: 33686904)
Clin J Am Soc Nephrol. 2017 May 8;12(5):854-863. (PMID: 28031417)
Am J Hosp Palliat Care. 2023 Oct;40(10):1106-1113. (PMID: 36708263)
BMJ Support Palliat Care. 2022 Jul;12(e2):e248-e255. (PMID: 31732661)
J Palliat Med. 2022 Jun;25(6):940-944. (PMID: 35196134)
Children (Basel). 2020 Aug 18;7(8):. (PMID: 32824811)
JAMA Netw Open. 2021 Aug 2;4(8):e2121517. (PMID: 34406399)
BMC Health Serv Res. 2022 Apr 22;22(1):539. (PMID: 35459204)
J Palliat Med. 2020 Nov;23(11):1500-1506. (PMID: 32589501)
BMJ Support Palliat Care. 2022 Jun;12(2):167-177. (PMID: 35144938)
BMC Palliat Care. 2021 Jul 30;20(1):122. (PMID: 34330245)
JAMA Intern Med. 2014 Dec;174(12):1994-2003. (PMID: 25330167)
J Palliat Med. 2022 Feb;25(2):234-242. (PMID: 34424777)
J Palliat Med. 2019 Jul;22(7):751-763. (PMID: 30688549)
J Palliat Care. 2024 Jan;39(1):3-12. (PMID: 36594209)

Keywords: clinical competence; health communication; palliative care; serious illness care program; serious illness conversations; systematic review

Date Created: 20240401 Date Completed: 20241024 Latest Revision: 20241109

20241109

PMC11528878

10.1177/08258597241245022

38557369