Pathways to Advance Targeted and Helpful Serious Illness Conversations
In a study published in the Journal of the National Comprehensive Cancer Network, researchers tested whether clinician and patient nudges (e.g., automated email reminders to clinicians and mailed letters to patients), would increase serious illness conversations among patients starting treatment associated with a poor prognosis. They found that combined clinician and patient nudges significantly increased documented conversations compared with no nudge (17.3% vs. 10.7%), driven largely by the clinician nudge, while the patient nudge alone had no effect. The authors also found that many conversations were missed by standard documentation and were only identified through natural language processing of clinicians' free-text notes, highlighting the importance of looking beyond structured EHR fields to fully capture serious illness conversations.