Effect of the Serious Illness Care Program in Outpatient Oncology: A Cluster Randomized Clinical Trial. The trial demonstrated significant reductions in moderate to severe anxiety and depression symptoms among serious illness conversation intervention patients in the total population. Learn More

Delivering More, Earlier, and Better Goals-of-Care Conversations to Seriously Ill Oncology Patients. The serious illness conversation intervention results in more, earlier, and better conversations about patient values and priorities, in addition to more patient-centered and retrievable documentation of goals of care in the medical record. Learn more

A Systematic Intervention to Improve Serious Illness Communication in Primary Care: Effect on Expenses at the End of Life. The study compared the medical expenses of seriously ill patients who had a Serious Illness Conversation to those of patients who did not during the last year of their lives. Expenses billed to Medicare were lower during the last six and three months of life for those who had conversations. The savings during the last three months averaged about $4,000 per patient for that period. Learn more

A Quality Improvement Initiative to Implement the Serious Illness Care Program on Hospital Medical Wards: Impact on Patient and Clinician Experience. After a serious illness conversation, 80% of patients or families rated the conversations as mostly or extremely worthwhile and felt more heard and understood. The majority (95%) of clinicians agreed that conversations could be done in an appropriate amount of time and 97% agreed that the Serious Illness Conversation Guide provided information that enhances clinical care. Learn more

A Systematic Intervention to Improve Serious Illness Communication in Primary Care. In a study of the serious illness communication program in fourteen primary care clinics participating in a high-risk care management program based in an accountable care organization, patients in the clinics with the program implemented were more likely than those in comparison clinics to have serious illness conversations—including discussion of values and goals—documented in patients’ medical records. Clinicians who participated also reported high satisfaction with training they received as part of the program, which they regarded as effective. Learn more

Serious Illness Conversations With Outpatient Oncology Clinicians: Understanding the Patient Experience. SICs are generally acceptable to oncology patients (nonharmful to the vast majority, positive for many). Qualitative analysis revealed six themes: clinician-patient relationship, impact on well-being, memorable characteristics of the conversation, improved prognostic understanding, practical planning, and family communication. Learn more

Evaluating an Intervention to Improve Communication Between Oncology Clinicians and Patients With Life-Limiting Cancer. This communication quality-improvement intervention resulted in more, earlier, better, and more accessible serious illness conversations documented in the EHR. This is the first such study to demonstrate improvement in all four of these outcomes. Learn more

Prior Advance Care Planning Is Associated with Less Decisional Conflict among Surrogates for Critically Ill Patients. Nearly half of surrogates for critically ill patients have moderate or high levels of decisional conflict. Prior advance care planning was associated with less decisional conflict. These results suggest that the scope of the benefit of advance care planning may extend beyond respecting patients’ wishes to also ameliorating the burden on patients’ loved ones who act as surrogates. Learn more

“And Then He Died” In this JAMA “Piece of My Mind” opinion piece by Joel Yager, MD, he speaks about the comfort he and his pediatrician wife have about their planning for their own ends of life, contrasting it with how most US residents die: “…they do not die the way they say they want to—at home, surrounded by the people who love them.” Learn more

Being Mortal by Atul Gawande, MD Medicine has triumphed in modern times, transforming the dangers of childbirth, injury and disease from harrowing to manageable. But when it comes to the inescapable realities of aging and death, what medicine can do often runs counter to what it should. Learn more

When Breath Becomes Air by Paul Kalinithi, MD In the opening paragraph, Paul Kalanithi, in his sixth year of a neurosurgery residency at Stanford, sits before a hospital computer looking at CT scans. He sees lungs “matted with innumerable tumors, the spine deformed, a full lobe of the liver obliterated. Cancer, widely disseminated. I’d examined scores of such scans. But this scan was different. It was my own.” Kalanithi describes his attempts to find meaning in his prognosis. Learn more

That Good Night by Sunita Puri, MD Between days spent waiting for her mother, an anesthesiologist, to exit the OR, and evenings spent in conversation with her parents about their faith, Puri witnessed the tension between medicine’s impulse to preserve life at all costs and a spiritual embrace of life’s temporality. And it was that tension that eventually drew Puri, a passionate but unsatisfied medical student, to palliative medicine–a new specialty attempting to translate the border between medical intervention and quality-of-life care. Learn more

Being Mortal—Atul Gawande on PBS Frontline FRONTLINE follows renowned New Yorker writer and Boston surgeon Atul Gawande as he explores the relationships doctors have with patients who are nearing the end of life. In conjunction with Gawande’s book, Being Mortal, the film investigates the practice of caring for the dying, and shows how doctors — himself included — are often remarkably untrained, ill-suited and uncomfortable talking about chronic illness and death with their patients. Learn more

When Breath Becomes Air—Lucy Kalanithi, MD Paul Kalanithi, MD, was a neurosurgery resident at Stanford and a loving husband when he was suddenly diagnosed with stage IV lung cancer. He died two years later at the age of 37, eight months after his infant daughter was born. His critically acclaimed memoir, finished with the help of his widow, Dr. Lucy Kalanithi, is a profound, searingly honest, and ultimately life-affirming meditation on the challenge of facing death and the relationship between doctor and patient. In this interview after Paul’s death, Lucy speaks about some of the insights Paul gained in the final year of his life—as both a physician and a patient. Learn more

POLST Minnesota The Provider Orders for Life Sustaining Treatment (POLST) form is a portable medical order that can give patients with advanced serious illness the option to exercise increased control over the treatment they do and do not want to receive at the end of life. Learn more.

MNHPC. The Minnesota Network of Hospice and Palliative Care provides resources and support for individuals facing serious illness or the end of life and their loved ones. They also provide education, advocacy, and networking opportunities as well as resources and tools for healthcare professionals in the hospice and palliative care communities. Learn more

C-TAC: The Coalition to Transform Advanced Care. C-TAC is an advocacy organization dedicated to improving the lives of people impacted by serious illness—the 12 million individuals, families and caregivers who struggle in a healthcare system that does not align with their values or needs. Learn more

CAPC: Center to Advance Palliative Care. The Center provides essential tools, training, technical assistance, and connection for all clinicians caring for people with a serious illness. Learn more

AMA Code of Medical Ethics’ Opinions Related to End of Life Care. From the Abstract: Physicians are responsible for assisting patients in creating plans for EOL care, encouraging discussion of this subject with sensitivity to patients’ situations, and respecting patients’ preferences for EOL care. Learn more

AMA—Advance Directives: How to Talk With Patients About Them. A patient’s comfort in contemplating, completing or even discussing an advance directive can greatly depend on what the physician has to say and offer. Learn more

Being Mortal by Atul Gawande, MD. Medicine has triumphed in modern times, transforming the dangers of childbirth, injury and disease from harrowing to manageable. But when it comes to the inescapable realities of aging and death, what medicine can do often runs counter to what it should. Learn more

A Senior’s Guide to Living Well, and Dying Well: Conversations That Matter by A. Stuart Hanson, MD.Written by a Minnesota physician, the book is an effort by an engaged group of seniors to address most questions of aging. Dr. Hanson has taken the content from years of expert group presentations and condensed them into into a readable, unique, and accessible guide for seniors and their families. Learn more

The Gray Zone: When Life Support No Longer Supports Life by Deborah Day Laxson. “If you've agreed to be a health care agent for your friend or loved one, you could find yourself in the gray zone – you likely never imagined yourself in that situation, nor what it would feel like to be entrusted with that level of responsibility.” Minnesota author Deborah Day Laxon’s book can help healthcare agents to prepare for and navigate through the overwhelming feelings and uncertainty they might face, offering clarity and understanding of what it means to put their own feelings aside to honor the wishes of their friend or loved one. Learn more

What Matters to Me Workbook:  A Workbook for People with Serious Illness. Developed in collaboration between Ariadne Labs and The Conversation Project, the What Matters to Me Workbook is designed to help people with a serious illness get ready to talk to their healthcare team about what is most important to them.

The Conversation Project. The Conversation Project® is a public engagement initiative co-founded in 2011 by Pulitzer Prize-winning writer Ellen Goodman and the Institute for Healthcare Improvement (IHI), a not-for-profit organization that is a leader in health and healthcare improvement worldwide. With tools, stories and other information, their goal is to help everyone talk about their wishes for care through the end of life, so those wishes can be understood and respected. Learn more

End in Mind Project.  Founded by Cathy Wurzer, who is a broadcast journalist with MPR News and Twin Cities PBS.  End in Mind’s primary goal is to lead a movement to change how our culture engages with loss, dying and death by inspiring individuals, their families and communities to explore their fears around death and dying, then creatively encouraging deeper inquiry into how to live with intention, purpose and meaning at any stage of life. Learn more.

Light the Legacy. With a mission to make advance care planning the community’s standard of care to ensure every adult Minnesotan’s healthcare choices are clearly defined and honored, this website offers Minnesota-specific information and tools including healthcare directive and POLST downloads. Learn more

POLST MinnesotaThe Provider Orders for Life Sustaining Treatment (POLST) form is a portable medical order that can give pati Learn moreents with advanced serious illness the option to exercise increased control over the treatment they do and do not want to receive at the end of life. Learn more.