Encouraging both doctors and patients to talk about serious illnesses can increase the number of conversations

Combining physician- and patient-led incentives may help promote serious illness conversations (SIC) in cancer care, according to a study published online July 1, 2019. JAMA network open.

Samuel U. Takvorian, MD, PhD, of the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, and his colleagues randomly assigned groups of doctors and patients to receive either standard care or incentives, resulting in four groups:

• Active follow-up, conducted for two years prior to study entry, consisting of sending text message reminders to physicians to complete SIC questionnaires in patients at high risk of mortality;
• Physician incentive only, including active follow-up and weekly comparisons of physicians’ SIC completion rates with other physicians;
• Patient-only incentive, including active follow-up and preclinical electronic communication to prepare patients for SIC;
• and joint encouragement from doctors and patients.

The analysis included 4,450 patients at high risk of death seen by 163 physicians in oncology clinics at four hospitals and six community health centers within a large academic health system.

The researchers found that the overall patient-level six-month SIC completion rate was 11.2% in the activity control group, 11.5% in the physician-incentive group, 11.5% in the patient-incentive group, and 14.1% in the combined-incentive group.

Combined incentives were associated with increased SIC scores (hazard ratio (rHR), 1.55; 95% confidence interval (CI), 1.00 to 2.40; P = .049) as compared with active control. However, physician incentives (HR, 0.95; 95% CI, 0.64 to 1.41; P = .79) and patient incentives (HR, 0.99; 95% 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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