Following the development of the Serious Illness Care Program (SICP) (Bernacki et al, 2015), which focuses on structured communication with seriously ill patients, there is scope for this protocol to be better understood for the benefit of those who are towards the end of life in palliative care. In brief: the protocol aims to ensure that patients receive care and support which is consistent with their wishes, beliefs and outcomes. This protocol lays a platform for early conversations about advanced care planning (ACP) with patients in the dying phase. Arguably, having such early conversations can be associated with achieving patients' dying wishes and, with that, managing the expectations of their families. It can also be argued that achieving these outcomes depends on a multitude of factors, some key ones being: getting the timing right for the patients to be willing and able to talk about future plans; the suitability of content for discussion; and whose initiative it is to begin such conversations. The Institute of Medicine (2015) puts forward an argument that, while patients may want to know and discuss prognostication, physicians focus their discussions on procedures (treat or not to treat; feed and hydrate, or not). One possible explanation is that these physicians may not be trained to handle such sensitive end-of-life situations and, hence, the introduction of the SICP (Bernacki et al, 2015). The SICP is also viewed as a solution needed to enhance weakness of ACP initiatives across palliative care settings through the use of trained specialised staff is communication skills. Such interventions are geared at ensuring that patients who are approaching death can experience calmness, peacefulness, hopefulness and some degree of control over their own illness and the decisions they make, which all arguably lead to reduced anxiety, enhanced quality of life and a dignified death. With these outcomes being achieved, it is possible that the bereaved may also experience less discomfort and distress following such deaths.
However, it is not clear, with no readily available evidence, whether such interventions support or enhance patients' experience at the end of life. With the shortage of healthcare staff and busy physicians, it is clear that not every patient will receive an early conversation about their dying preferences. In the UK, healthcare staff with advanced communication skills stretch beyond physicians, and there is a need for training in order to integrate such conversations with all palliative care patients. A descriptive study by Paladino et al (2020) concluded that both patients and clinicians in oncology settings had positive experiences of using the SICP techniques. Such reports are encouraging for palliative care when introducing ACP in hospitals and the community. Community nurses can be assured that, while patients may want information about the progress of their illness, they may also be ambivalent about receiving (hearing) real facts about their worsening health and limited future opportunities. Therefore, it is important that ACP discussions are started early in a patient's health trajectory and, where possible, community nurses' confidence can be enhanced by attending a serious illness conversation training program to foster the skills needed to achieve person-centred dialogue with patients and establish their values, beliefs, wishes and preferences. While this program was first developed to train oncology nurses, it can benefit community nurses and other non-palliative care clinicians to integrate best practice in ACP by ensuring a welcome balance between patients' wishes/preferences and clinical intervention while delivering enhanced quality of life for the patients. Finally, community nurses should continue to work closely with palliative care doctors, specialist nurses and hospice-based staff, who are an excellent source of knowledge and support. It is important that we get the care of seriously ill patients right the first time, and these resources can go a long way towards achieving this for all patients.