Perceptions of Patient-Clinician Communication Among Adults With and Without Serious Illness.

Importance: High-quality, person-centered patient-clinician communication is critical in health care and may be less effective for patients with serious illness. Little is understood about differences in patient-clinician communication experiences of adults with and without serious illness.

Objectives: To determine whether perceptions of patient-clinician communication experiences differ between adults with and without serious illness.

Online Forums as a Tool for Broader Inclusion of Voices on Health Care Communication Experiences and Serious Illness Care: Mixed Methods Study.

Background: Existing health care research, including serious illness research, often underrepresents individuals from historically marginalized communities. Capturing the nuanced perspectives of individuals around their health care communication experiences is difficult. New research strategies are needed that increase engagement of individuals from diverse backgrounds.

Training Novice Raters to Assess Nontechnical Skills of Operating Room Teams.

Objective: To our knowledge, no curricula have been described for training novice, nonclinician raters of nontechnical skills in the operating room (OR). We aimed to report the reliability of Oxford Non-Technical Skills (NOTECHS) ratings provided by novice raters who underwent a scalable curriculum for learning to assess nontechnical skills of OR teams.

Design: In-person training course to apply the NOTECHS framework to assessing OR teams' nontechnical skill performance, led by 2 facilitators and involving 5 partial-day sessions of didactic presentations, video simulation, and live OR observation with postassessment debriefing.

Serious Illness Conversations With Outpatient Oncology Clinicians: Understanding the Patient Experience.

Purpose: Guidelines recommend earlier advance care planning discussions focused on goals and values (serious illness communication) among oncology patients. We conducted a prospective, cross-sectional quality improvement evaluation of patients who had a serious illness conversation (SIC) with an oncology clinician using the Serious Illness Conversation Guide to understand patient perceptions of conversations using a structured guide.

Methods: We contacted 66 oncology patients with an SIC documented in the electronic health record.

Measuring Goal-Concordant Care: Results and Reflections From Secondary Analysis of a Trial to Improve Serious Illness Communication.

Context: Many consider goal-concordant care (GCC) to be the most important of advance care planning and palliative care. Researchers face significant challenges in attempting to measure this outcome. We conducted a randomized controlled trial to assess the effects of a system-level intervention to improve serious illness communication on GCC and other outcomes.

Effect of the Serious Illness Care Program on Health Care Utilization at the End of Life for Patients with Cancer.

To determine the effect of the Serious Illness Care Program on health care utilization at the end of life in oncology. Analysis of the secondary outcome of health care utilization as part of a cluster-randomized clinical trial that ran from 2012 to 2016. Clinicians in the intervention group received training, coaching, and system supports to have discussions with patients using a Serious Illness Conversation Guide (SICG); clinicians in the control arm followed usual care.

Training Clinicians in Serious Illness Communication Using a Structured Guide: Evaluation of a Training Program in Three Health Systems.

Failure to initiate discussions about patients' values and goals in serious illness remains a common problem. Many clinicians are inadequately trained for these discussions. Evaluate whether a novel train-the-trainer model results in high-quality training that improves clinicians' self-reported competencies in serious illness communication.

Effect of the Serious Illness Care Program in Outpatient Oncology: A Cluster Randomized Clinical Trial.

Importance: High-quality conversations between clinicians and seriously ill patients about values and goals are associated with improved outcomes but occur infrequently.

Objective: To examine feasibility, acceptability, and effect of a communication quality-improvement intervention (Serious Illness Care Program) on patient outcomes.

Design, Setting, And Participants: A cluster randomized clinical trial of the Serious Illness Care Program in an outpatient oncology setting was conducted.

Evaluating an Intervention to Improve Communication Between Oncology Clinicians and Patients With Life-Limiting Cancer: A Cluster Randomized Clinical Trial of the Serious Illness Care Program.

Importance: Earlier clinician-patient conversations about patients' values, goals, and preferences in serious illness (ie, serious illness conversations) are associated with better outcomes but occur inconsistently in cancer care.

Objective: To evaluate the efficacy of a communication quality-improvement intervention in improving the occurrence, timing, quality, and accessibility of documented serious illness conversations between oncology clinicians and patients with advanced cancer.

Design, Setting, Participants: This cluster randomized clinical trial in outpatient oncology was conducted at the Dana-Farber Cancer Institute and included physicians, advanced-practice clinicians, and patients with cancer who were at high risk of death.

A Qualitative Study of Serious Illness Conversations in Patients with Advanced Cancer.

Conversations with seriously ill patients about their values and goals have been associated with reduced distress, a better quality of life, and goal-concordant care near the end of life. Yet, little is known about how such conversations are conducted. To characterize the content of serious illness conversations and identify opportunities for improvement.

A Descriptive Analysis of End-of-Life Conversations With Long-Term Glioblastoma Survivors.

Background: Early, high-quality serious illness (SI) conversations are critical for patients with glioblastoma (GBM) but are often mistimed or mishandled.

Objective: To describe the prevalence, timing, and quality of documented SI conversations and evaluate their focus on patient goals/priorities.

Design/participants: Thirty-three patients with GBM enrolled in the control group of a randomized controlled trial of a communication intervention and were followed for 2 years or until death.

Effectiveness of developmental screening in an urban setting.

Objective: To determine the effectiveness of developmental screening on the identification of developmental delays, early intervention (EI) referrals, and EI eligibility.

Methods: This randomized controlled, parallel-group trial was conducted from December 2008 to June 2010 in 4 urban pediatric practices. Children were eligible if they were <30 months old, term, without congenital malformations or genetic syndromes, not in foster care, and not enrolled in EI.

A family psychosocial risk questionnaire for use in pediatric practice.

The objective of this study is to develop new methods to better identify psychosocial risk such that children with the greatest risk of poor future outcomes receive more intensive preventive health services. Based on structured literature review and secondary data analysis, a 52-item psychosocial risk questionnaire was administered to 2,083 families of children (<36 months). To quantify the questionnaire's construct validity, developmental concern was assessed with the Ages and Stages Questionnaire version II (ASQ) [n = 1,163].

Reading level of Medicaid renewal applications.

Objective: To examine compliance of Medicaid-renewal applications to established state guidelines for reading level of Medicaid-related materials.

Methods: We assessed the reading level of the 2008 Medicaid renewal applications by using 3 readability tests: Flesch-Kincaid Grade Level Index, New Fog Count, and FORCAST.

Results: In 2008, 45 states and the District of Columbia had reading level guidelines for Medicaid-related materials.

Influence of maternal health literacy on child participation in social welfare programs: the Philadelphia experience.

We examined the influence of maternal health literacy on child participation in social welfare programs. In this cohort, 20% of the mothers had inadequate or marginal health literacy. Initially, more than 50% of the families participated in Temporary Assistance for Needy Families (TANF), the Food Stamp Program, and Special Supplemental Nutrition Program for Women, Infants, and Children, whereas fewer than 15% received child care subsidies or public housing.