An inpatient Serious Illness Care Program for older patients with hematologic malignancies: a single-arm pilot study

ABSTRACT: The Serious Illness Care Program (SICP) is an evidence-based intervention designed to systemically implement serious illness conversations (SICs) into clinical practice. We previously piloted the SICP via telehealth for patients in the ambulatory setting. However, many patients with hematologic malignancies experience frequent hospitalizations, providing a key opportunity to conduct SICs in the inpatient setting. The purpose of this study was to assess the feasibility of an inpatient SICP and describe completion of advance directives and SIC documentation after SICP implementation. This was a single-arm pilot study including patients aged ≥60 years with hematologic malignancies and their caregivers. Clinicians (advanced practitioners; hematology/oncology fellows) completed a 2- to 3-hour virtual training on the SICP. The primary outcome was feasibility (retention rate: percentage of consented patients who completed the SICP visit, with >70% considered feasible). Secondary outcomes were advance directive completion (Health Care Proxy [HCP] and Medical Orders for Life-Sustaining Treatment [MOLST]) and documentation. We also collected data on advance care planning (ACP) engagement and disease understanding. We included 41 patients (mean age, 68 years), 24 caregivers, and 22 clinicians; 38 SICP visits were completed (retention rate of 92.7%). The number of HCP and MOLST forms completed increased from 23 to 31 and from 7 to 20 within 1 year of the SICP visits, respectively. All SICP visits were documented. ACP engagement numerically increased (P = .24), and patients found the intervention to be acceptable. Patient estimates of life expectancy may have shifted after the SICP visit. The inpatient SICP was feasible, with potential increase in advance directive completion. This trial was registered at www.clinicaltrials.gov as #NCT05433090.