Serious Illness

CME credit available from Harvard Medical School through April 2023.

Published Materials

• Summary Brochure
• Evidence Document
• Serious Illness Conversation Guide

This module helps primary care clinicians apply palliative care principles to help patients with serious illness and their families relieve symptoms and stress, and plan for the future.

Serious illness is any health condition that either negatively impacts a person’s daily function or quality of life, or excessively strains their caregivers and carries a high risk of death in the next year.¹ Palliative care can improve quality of life for people with serious illness.²

As reflected in hospice enrollment, the conditions of patients who enter hospice encompass more than cancer.³

Planning for end-of-life care should occur far in advance of hospice. Advance care planning (ACP) is a continuous, dynamic process of reflection and communication among patients, those close to them, and health care professionals.

The goal is to provide care that best fits the patient’s values, goals, and preferences during serious illness.⁴

As a patient’s condition evolves, use tools to develop and share important decisions

Getting started with serious illness conversations can be difficult. Available tools help guide patients and families through key decisions. See links below.

A structure to frame the conversation and tips for questions to facilitate discussion can aid primary care clinicians.

1. Enable the discussion
2. Assess understanding and preferences
3. Share the prognosis
4. Explore key topics
5. Make recommendations and formulate a plan

Specific language and questions are available in the Serious Illness Conversation Guide at the top of the page.

Primary care clinicians help guide patients and families through the course of illness, managing symptoms such as pain, nausea, fatigue, and constipation, along the way. Reminders of best practices and symptom management tips are provided in the Summary Brochure at the top of the page.

Primary care providers are an integral part of guiding patients and families along the trajectory of serious illness, through end of life. Facilitating these key decisions along the progression of illness helps families and patients make choices that best reflect a patient’s preferences.

Resources for Providers

• Serious Illness Care Program
• VitalTalk
• Pennsylvania POLST tools
• POLST form
• Find Pennsylvania Health Care Facilities – Hospice
• National Hospice and Palliative Care Organization
• COVID resources at VitalTalk and the Serious Illness Care Program

Resources for Patients

• The Conversation Project
• PREPARE for your care
• Five Wishes
• Go Wish
• Get Palliative Care
• National Hospice and Palliative Care Organization

Information current at time of publication, April 2021.

The content of this website is educational in nature and includes general recommendations only; specific clinical decisions should only be made by a treating clinician based on the individual patient’s clinical condition.

References

1. Kelley AS, Bollens-Lund E. Identifying the Population with Serious Illness: The “Denominator” Challenge. J Palliat Med. 2018;21(S2):S7-s16.
2. Center to Advance Palliative Care. About palliative care. https://www.capc.org/about/palliative-care/. Accessed February 24, 2021.
3. Epidemiology And Patterns Of Care At The End Of Life: Rising Complexity, Shifts In Care Patterns And Sites Of Death. Health Affairs. 2017;36(7):1175-1183.
4. Sudore RL, Lum HD, You JJ, et al. Defining Advance Care Planning for Adults: A Consensus Definition From a Multidisciplinary Delphi Panel. Journal of Pain and Symptom Management. 2017;53(5):821-832.e821.