Progress in palliative care: serious illness conversations for community nurses

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.