The Importance of Difficult Conversations in Medicine

Implementing the Serious Illness Care Program (SICP) With Stanford Department of Medicine and Ariadne Labs

A map of the reach of the Serious Illness Care Program

Seriously ill patients, particularly those who are unlikely to recover, need to have conversations with the clinicians who care for them.  The obvious ones, of course, are about medical care  and the practicalities of all the logistics it involves. But patients also benefit from the less obvious conversations, the ones about values and goals and how they want to live.

These conversations often happen on the fly, and even more often they happen too late, not before the difficult moment comes but after. And that’s where the Serious Illness Care Program comes in.  

What is the Serious Illness Care Program (SICP)? 

SICP strives to give clinicians tools to discover the things that are most important to patients.

The program seeks to give a voice to patients’ wishes as they continue through their journey with a serious illness.  Far too often, the things that are most important to patients are missing from the medical record.  And if patient’s most important goals aren’t documented prominently in the medical record, members of his or her care team may not be aware of them.   

To address this at Stanford, the Stanford Department of Medicine partnered with Ariadne Labs in 2018 to launch the Serious Illness Care Program (SICP). SICP is an advance care planning initiative developed by Atul Gawande, a surgeon, writer, and healthcare leader as well as a professor of medicine at Harvard, and Susan Block, a Harvard palliative care physician.  They created the guide, which was further developed and tested by a few of their colleagues at Ariadne Labs, a joint venture between the Harvard T.H. Chan School of Public Health and Brigham and Women’s Hospital.

As of 2021, the program has been implemented at Stanford in both the Cancer Center and Hospital Medicine, as well as in various health systems across the country and the world.

For more information about the program, please click here.

A Helpful Guide to Patient Interaction

The program and its trainings start with a communications guide that walks physicians and other medical staff through the process of the conversation, beginning with acknowledging a patient’s interest in the discussion (“How much interest about what is likely ahead with your illness would you like from me?”) and continuing into more concrete details about the patients’ goals (“What abilities are so critical to your life that you can’t imagine living without them?”).

Once the conversation takes place, ideally early in the patient’s clinical course, the patient’s wishes are then documented in the EMR in a special “advance care planning form” section, so that all members of a patient’s medical team have access, and key carers are alerted and informed.  The patient’s wishes are thus respected and acknowledged.

The form is of course only one part of the many things the SICP does; another key aspect is education.  Clinicians are also trained using live facilitation and standardized patients to walk them through the processes of these difficult conversations.  To date, Stanford has trained 500+ clinicians from over 10 different disciplines.    

At Stanford alone, then, the SICP is responsible for thousands of these conversations and consultations.  But what is it like to use this program and its tools with real patients?  We spoke to several people, ranging from physicians to medical staff, who told us their stories about the program.

Stories of SICP Clinicians

Click on a name to see an individual's story

May Carr on helping patients get excellent nutritional care

Pooja Rao on the power of discussing a patient's goals and fears

Alice Fan on teaching colleagues and bridging the gap between patient and clinician

Samantha Wang on preparation and guidance for difficult conversations

Brian Rogers on his experience as a care coach