Pivoting to serious illness conversations to meet advance care planning quality measures in academic primary care clinics

Grant M Smith; Anuradha Phadke; Briththa Seevaratnam; Rebecca Fong; Ana Calugar; Winifred G Teuteberg; Rachelle E Bernacki

doi:10.1016/j.hjdsi.2026.100777

Pivoting to serious illness conversations to meet advance care planning quality measures in academic primary care clinics

Healthc (Amst). 2026 Jun;14(1):100777. doi: 10.1016/j.hjdsi.2026.100777. Epub 2026 Feb 15.

Authors

Grant M Smith¹, Anuradha Phadke², Briththa Seevaratnam³, Rebecca Fong³, Ana Calugar⁴, Winifred G Teuteberg⁵, Rachelle E Bernacki⁶

Affiliations

¹ Stanford University School of Medicine, Section of Palliative Medicine, Division of Primary Care and Population Health, Stanford, CA, USA. Electronic address: smithgra@stanford.edu.
² Stanford University School of Medicine, Division of Primary Care and Population Health, Stanford, CA, USA.
³ Stanford University School of Medicine, Department of Medicine, Serious Illness Care Program, Stanford, CA, USA.
⁴ Stanford Health Care, Ambulatory Quality, Stanford, CA, USA.
⁵ Stanford University School of Medicine, Section of Palliative Medicine, Division of Primary Care and Population Health, Stanford, CA, USA.
⁶ Dana-Farber Cancer Institute, Department of Supportive Oncology, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.

PMID: 41698273
DOI: 10.1016/j.hjdsi.2026.100777

Abstract

Purpose: As novel payment models incentivize advance care planning (ACP) in primary care, conversation-focused models of ACP that prioritize serious illness conversations (SICs), which focus on discussing patients' understanding of their illness and their goals and values, can make meeting quality measures more clinically impactful.

Methods: We implemented the Serious Illness Care Program (SICP), an evidence-based ACP intervention, in academic primary care clinics. SICP supports healthcare systems to increase SICs through clinician training, coaching, and integrating a documentation module within the electronic medical record. Key facilitators of our implementation included adapting SICP training to accommodate primary care providers' (PCPs) schedules, financial incentives for PCPs to complete SICP training and SICs, support of a physician ACP quality lead role, leadership support, and information technology collaboration.

Results: Throughout the 2023 and 2024 fiscal years, 59 of the 84 faculty PCPs (70%) in our primary care clinics completed SICP training. Of the SICP-trained PCPs, 41 (69%) completed at least one SIC. During the implementation, 340 SICs were documented for 238 unique patients.

Conclusion and implications: While additional work is needed to increase rates of PCPs completing SICs, we found that implementing SICP in academic primary care clinics is feasible when incentives, leadership support, and champions are in place.

Keywords: Advance care planning; Communication training; Physician training; Quality improvement; Serious illness communication.

Publication types

Case Reports

MeSH terms

Advance Care Planning* / standards
Advance Care Planning* / trends
Communication*
Humans
Primary Health Care / standards
Quality Indicators, Health Care* / standards