Energizing both doctors and patients can increase conversations about serious illnesses

TUESDAY, July 2, 2024 (HealthDay News) — Combining physician- and patient-driven incentives can help promote serious illness conversations (SICs) in cancer care, according to a study published online July 1 in the journal HealthDay News. JAMA network open.

Samuel U. Takvorian, MD, PhD, of the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, and colleagues randomly assigned physician and patient groups to receive either standard care or incentives, resulting in four arms: (1) active control, running for 2 years before the study began, consisting of text message reminders from physicians to complete the SIC for patients at high risk of mortality; (2) physician incentives only, consisting of active control plus weekly comparisons of physician-level SIC completion rates; (3) patient incentives only, consisting of active control plus preclinical electronic communication to prepare patients for the SIC; and (4) combined physician and patient incentives. The analysis included 4,450 patients at high risk of mortality seen by 163 physicians in oncology clinics at four hospitals and six community centers within a large academic health system.

The investigators found that overall, patient-level six-month SIC completion rates were 11.2 percent in the active control group, 11.5 percent in the clinical incentive group, 11.5 percent in the patient incentive group, and 14.1 percent in the combined incentive group. The combined incentive was associated with an increase in SIC rates (ratio of hazard ratios (rHR), 1.55; 95 percent confidence interval (CI), 1.00 to 2.40; P = .049) compared with the active control group. However, clinical incentives (HR, 0.95; 95 percent CI, 0.64 to 1.41; P = .79) and patient incentives (HR, 0.99; 95 percent CI, 0.73 to 1.33; P = .93) were not associated with increased SIC scores.

“Our study may encourage the development of future implementation strategies that more broadly improve the goals of care documentation and patient-physician communication,” the authors write.

Several authors have disclosed ties to the pharmaceutical industry.

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