Is Training Alone Enough? A Comparison of Serious Illness Communication Training With and Without Implementation Strategies.

Background: Communication skills training alone has shown limited impact on improving the frequency and quality of serious illness conversations (SICs). Implementing structured support strategies may enhance both adoption and sustained use in clinical practice. Design: Retrospective review of the impact of Serious Illness Care Program (SICP) training and implementation in outpatient and inpatient settings at a single academic center. Setting: Stanford Health Care is a health system affiliated with the Stanford School of Medicine, with 2 hospital campuses and 60 ambulatory practices throughout the San Francisco Bay Area. Participants: Physicians, physicians-in-training, advanced practice providers, and allied health professionals (occupational therapists, dieticians, social workers, and case managers) across departments. Intervention: From October 2020 to May 2023, our institution implemented the SICP, offering two communication skills training modalities: (1) Training Only and (2) Training with Implementation support, which included patient identification, data feedback, coaching, and department-specific quality improvement incentives. Analysis: We compared the adoption of SICs by examining the documentation frequencies of trained clinicians. Clinicians were categorized as never user (0 conversations), seldom users (1-4 conversations), occasional users (5-11 conversations), and frequent users (12 or more conversations) according to the number of documented SICs within one year after training. We also assessed the number of sustained users, defined as clinicians who documented SICs at least once a month over a six-month period following training. Results: Within the first 12 months of training, the Training Only group had a significantly higher percentage of never users compared with the Training with Implementation cohort (78.9% vs. 57.6%, p < 0.01). The Training with Implementation group had higher SICs documented across all other usage categories: seldom users (23.5% vs. 14.6%, p < 0.01), occasional users (10.2% vs. 4.2%, p < 0.01), and frequent users (8.5% vs. 2.2%, p < 0.01). Compared with the Training Only group, the Training with Implementation group also had more sustained users (9.4% vs. 1.6%, p < 0.01) who consistently documented SIC monthly for six months. Conclusion: Implementation support strategies enhance both the initial adoption and sustained use of SICs beyond training alone.