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

Rachelle Bernacki
Joanna Paladino
Bridget A. Neville
Journal Article
March 2019

This resource provides an overview of a quality-improvement intervention focused on communication with patients with advanced cancer. 

  • High-quality conversations between clinicians and seriously ill patients about values and goals are associated with improved outcomes but occur infrequently.
  • A cluster randomized clinical trial of the Serious Illness Care Program in an outpatient oncology setting was conducted of 278 patients with advanced cancer.
  • The coprimary outcomes included goal-concordant care and peacefulness at the end of life. Secondary outcomes included therapeutic alliance, anxiety, depression, and survival.
  • The results were null with respect to goal-concordant care and peacefulness at the end of life. But the trial demonstrated significant reductions in moderate to severe anxiety and depression symptoms among intervention patients, suggesting the need for further study.
  • Methodological challenges for the primary outcomes limit the conclusions that can be drawn about those outcomes.
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Population Addressed
People with Advanced Illness
Key Questions Answered
  • What were the effects of an intervention designed to enhance communication between clinicians and patients with advanced cancer?
Level of Evidence
What does this mean?