Journal of palliative medicine
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Background: Patients with serious illness benefit from conversations to share prognosis and explore goals and values. To address this, we implemented Ariadne Labs' Serious Illness Care Program (SICP) at Stanford Health Care. Objective: Improve quantity, timing, and quality of serious illness conversations. ⋯ Clinicians across eight disciplines engaged in these conversations. Identified barriers that included leadership engagement, complex workflows, and patient identification. Conclusion: Several factors contributed to successful SICP implementation across clinical sites: innovative clinical workflows, machine learning based predictive algorithms, and nonphysician care team member engagement.
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Institutional transference is a phenomenon describing patients' attitudes toward the institutions where they receive mental health or medical care. While transference toward individual clinicians in palliative care has been described, attitudes of patients with serious illness toward the institutions where they receive specialized care have not been described. ⋯ We consider three conditions: (1) the idealized reputation of the academic cancer center, often a tertiary referral center; (2) loss of an institutional connection during care transitions; and (3) countertransferential reactions to institutional transference. We highlight characteristics and personality styles of individuals with cancer that may complicate and intensify institutional transference and identify potential interventions to address common challenges associated with institutional transference.
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Background: Practicing physicians require serious illness communication (SIC) skills to ensure high-quality, humanistic care for patients and families as they face life-changing medical decisions. However, a majority of U. S. medical schools do not require formal training in SIC and fail to provide students deliberate practice before graduation. ⋯ Conclusions: Medical schools are failing to consistently train and ensure basic competency in effective, compassionate SIC. Curriculum mapping allows schools to evaluate their current state on a particular topic such as SIC, ensure proper assessment, and evaluate curricular changes over time. Through the deliberate inclusion of SIC competencies in longitudinal curriculum design, we can fill this training gap and create best practices in undergraduate medical education.
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Artificial intelligence (AI) is changing the way clinicians practice medicine, and recent technological advancements have resulted in consumer-facing products that can respond to users with dynamic and nuanced language. Clinicians typically struggle with serious illness communication, such as delivering news about a poor prognosis. ⋯ This article explores the allure of employing AI-powered chatbots to assist nonspecialist clinicians with serious illness communication and highlights the ethical and practical drawbacks. While outsourcing communication to new AI chatbot technologies may be inappropriate, there is a role for AI in training clinicians on effective language to use when discussing serious illness with their patients.