Karen Okrainec, MD is a General Internal Medicine physician and clinician scientist at UHN, and VitalTalk faculty partnering with The Conversation Lab research team to advance serious illness communication implementation work across UHN sites.
Richard Dunbar-Yaffe, MD is a General Internal Medicine physician and Assistant Professor in Clinician Quality and Innovation at UHN. His academic interests include developing, implementing, and evaluating novel models of clinical care.
Below is a spotlight on a recent collaboration:
Grants from the PMH Oncology Foundation, GIM Acute Oncology Quality Improvement Research Fund and Dr. Frances Shepherd – TGH QI Innovation Hub were used to fund the Serious illness Communication Study. The authors also received help from the UHN Patient Partner program.
Authors: Isabelle Caven, Warren Lewin, Helen James, Amy Troup, Rajdeep Kaler, Leanne Kim, Senyo Agbeyaka, Aivan Chau, Richard Dunbar-Yaffe, Karen Okrainec and Melissa Frew
Collaborators: Neesha Dhani and Breffni Hanon
Designer: Eliot El Zeinaty
Objectives: The study aimed to characterize the documentation and experiences of serious illness conversations, encompassing code status, goals of care, advance care planning, and values-based discussions, from the perspectives of both patients with cancer and those on general internal medicine (GIM) wards.
Methods: The team reviewed hospital chart data, surveyed clinicians, and interviewed patients and caregivers.
Results: The top 5 reported barriers to serious illness conversations are:
1. Language barriers
2. Uncertainty in estimating prognosis
3. Lack of time to have conversations
4. Perceived discomfort to discuss GOC in some cultures
5. Lack of agreement amongst family members about GOC
Design Principles for Talking Serious Illness informed from co-design workshops:
More findings are illustrated in the infographic below:
publication forthcoming in 2025
