ideasIdea
Train every oncology team in serious-illness conversations and prompt them in the record
Patients with advanced cancer often never have a clear conversation about what to expect and what matters to them. A structured conversation guide, taught to clinicians and prompted by the record, makes these talks happen earlier.
The Serious Illness Care Program (Ariadne Labs) combines clinician training in a structured conversation guide with electronic prompts and documentation. A cluster-randomised trial in oncology showed earlier, more frequent, and more patient-centred conversations and reduced anxiety and depression. Adoption remains limited. Making the programme a standard component of oncology practice would improve goal-concordant care at low cost.
Hypothesis
Systematic implementation will raise the proportion of patients with advanced cancer who have a documented goals-of-care conversation before their last month of life from under 40% to above 80%, and reduce non-beneficial intensive care at end of life.
Rationale
Trial evidence exists; the intervention is training and prompts, which scale cheaply.
What would test it
A stepped implementation across a health system with conversation documentation timing, end-of-life care intensity, and bereaved family ratings as endpoints.
Maturity
being tested at scale
Who has to act
clinic
Cost to try
Small (under $1M)
Years to first evidence
2
Bottlenecks it attacks
- Pain relief and palliative care are unavailable to most · Most people who die of cancer worldwide do so without adequate pain relief.
- Patients lack understanding, navigation and agency · Most patients cannot understand their options, find trials, or push back, so decisions are made for them.