Serious Illness Conversations in Hospital Medicine: Assessing Self-Perceived Knowledge and Skills

Introduction Serious illness conversations (SICs) are structured discussions intended to align medical care and treatment decisions with patients’ values, goals, priorities, and preferences, often referred to as goals of care discussions. Despite the importance of these conversations, clinicians receive no standardized training. As hospitalists often lead SICs, we sought to assess baseline knowledge and perceptions surrounding SICs to help understand potential needs and interventions. Methods A cross-sectional survey was distributed to hospital medicine clinicians at 1 academic medical center. The survey was open for 6 weeks and sought to assess clinician knowledge, self-perceptions of skills, wellness, and documentation. Descriptive statistics and inductive thematic approach were conducted. Results There were 55 (43%) responses, with 74.6% being physicians. The majority of respondents had no prior SIC training. For individuals who don’t use a framework during SICs, 32 reported a framework would be beneficial. Respondents reported high confidence in self-perception of SIC communication skills, but 0% exclusively identified the correct timepoints to be conducting SICs. Clinicians reported high awareness of communication tools and skills, however routine usage remained low. Clinicians reported multiple documentation locations in the electronic medical record, and only 18 (32.7%) reported knowing how to bill for these conversations. Conclusions This study found a discordance between clinicians’ high self-perception of knowledge of communication skills and appropriate SIC timepoints when compared to a lower self-reported usage of skills. Future studies should focus on educating hospital medicine providers on appropriate communication timepoints and transitioning communication technique awareness to routine usage.