Are Safety-Net Primary Care Physicians Prepared to Engage in Serious Illness Conversations?

Background: Advance Care Planning (ACP) has not reliably improved care for patients at end-of-life. Serious Illness Conversations when patients are in the late stages of chronic illness might be more effective to address patients' goals. The Serious Illness Conversation (SIC) Guide has been helpful but was not developed for use in safety-net settings serving racial and ethnic minority populations.

"I was not able to keep myself away from tending to her immediate needs": Primary Care Physicians' Perspectives of Serious Illness Conversations at Community Health Centers.

Purpose: Seriously ill patients in low-income and minority populations have lower rates of advance care planning. Initiatives that promote serious illness (SI) conversations in community health centers (CHCs) can reach broad, diverse patient populations. This qualitative study explored the experiences of primary care physicians in conducting SI conversations at CHCs in order to understand challenges and needs in this setting.

Exploring the spiritual/religious dimension of patients: a timely opportunity for personal and professional reflection for graduating medical students.

Teaching about spirituality in medical school training is lacking. Spirituality is a dimension of humanity that can put experiences of health and illness into a meaningful context. Medical students might benefit from understanding how spirituality is an important element in learning to care for patients.

The clinical ethics credentialing project: preliminary notes from a pilot project to establish quality measures for ethics consultation.

The Clinical Ethics Credentialing Project (CECP) was intiated in 2007 in response to the lack of uniform standards for both the training of clinical ethics consultants, and for evaluating their work as consultants. CECP participants, all practicing clinical ethics consultants, met monthly to apply a standard evaluation instrument, the "QI tool", to their consultation notes. This paper describes, from a qualitative perspective, how participants grappled with applying standards to their work.

Charting the future. Credentialing, privileging, quality, and evaluation in clinical ethics consultation.

Clinical ethics consultation has become an important resource, but unlike other health care disciplines, it has no accreditation or accepted curriculum for training programs, no standards for practice, and no way to measure effectiveness. The Clinical Ethics Credentialing Project was launched to pilot-test approaches to train, credential, privilege, and evaluate consultants.

The effect of physician solicitation approaches on ability to identify patient concerns.

Context: Studies showing that physicians often interrupt the patient's opening statement assume that this compromises data collection.

Objective: To explore the association between such interruptions and physician accuracy in identifying patient concerns.

Design: This study replicates the Beckman-Frankel methodology and adds exit interviews to assess physician understanding.