ideasIdea

Train every oncology team in serious-illness conversations and prompt them in the record

Patients with advanced cancer often never have a clear conversation about what to expect and what matters to them. A structured conversation guide, taught to clinicians and prompted by the record, makes these talks happen earlier.

The Serious Illness Care Program (Ariadne Labs) combines clinician training in a structured conversation guide with electronic prompts and documentation. A cluster-randomised trial in oncology showed earlier, more frequent, and more patient-centred conversations and reduced anxiety and depression. Adoption remains limited. Making the programme a standard component of oncology practice would improve goal-concordant care at low cost.

Hypothesis

Systematic implementation will raise the proportion of patients with advanced cancer who have a documented goals-of-care conversation before their last month of life from under 40% to above 80%, and reduce non-beneficial intensive care at end of life.

Rationale

Trial evidence exists; the intervention is training and prompts, which scale cheaply.

What would test it

A stepped implementation across a health system with conversation documentation timing, end-of-life care intensity, and bereaved family ratings as endpoints.

Maturity

being tested at scale

Who has to act

clinic

Cost to try

Small (under $1M)

Years to first evidence

Bottlenecks it attacks

Pain relief and palliative care are unavailable to most · Most people who die of cancer worldwide do so without adequate pain relief.
Patients lack understanding, navigation and agency · Most patients cannot understand their options, find trials, or push back, so decisions are made for them.

Connected

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Supportive Care & Survivorship

bottlenecks

Pain relief and palliative care are unavailable to most Patients lack understanding, navigation and agency