Adapting and implementing the Serious Illness Care Programme for outpatient oncology, cardiology and palliative medicine clinics: a mixed-methods feasibility study

Objectives To evaluate the feasibility of implementing a coordinator-facilitated Serious Illness Care Programme (SICP) in outpatient oncology, cardiology and palliative medicine clinics. Design Single-arm, mixed-methods, prospective feasibility study conducted over three sequential phases across 9 months, guided by the Reach, Effectiveness, Adoption, Implementation, Maintenance framework.

Setting Outpatient oncology, cardiology and palliative medicine clinics in two tertiary medical centres in Singapore. Participants Eleven clinicians (eight doctors and three nurses) participated.

Clinicians had prior serious illness conversation (SIC) training and were purposively sampled for diversity in specialty, seniority and mode of care delivery. One participant disengaged midway due to concerns about intervention fit but completed endline measures.

A total of 101 patients participated in an SIC during the intervention period. Interventions Implementation supports were developed with reference to the Capability, Opportunity, Motivation - Behaviour model of behaviour change, and adapted to the workflows and needs of participating clinicians.

These included email reminders, in-person prompting by a coordinator, access to a locally adapted SIC guide, a structured documentation template and optional patient preparation materials. Supports were introduced in full during phase 2, with in-person prompting and support withdrawn in phase 3.

Primary and secondary outcome measures Feasibility was the primary outcome, operationalised through clinician perceptions of implementation support (acceptability) and the proportionality of implementation effort to observed benefits (practicality). Secondary outcomes included SIC engagement rates (reach), clinician retention (adoption) and continuity intentions among clinicians (maintenance).

Results Clinician retention was 91% (n=10/11) with the only dropout being in the cardiology setting. Most clinicians felt support was acceptable and adequate (n=9/11).

While 101 patients had SICs, engagement activity in oncology and cardiology declined following the withdrawal of in-person prompting, while engagement among palliative medicine clinicians remained stable or increased. Coordinator time commitment decreased by 75.8% between phases 2 and 3.

Key barriers faced by clinicians included the documentation burden. Additionally, there was a perceived lack of fit in outpatient cardiology.

Conclusions A coordinator-facilitated SICP is feasible and acceptable in outpatient oncology and palliative care settings. Active coordination reduces clinician burden.

As in-person prompting may be necessary to sustain engagement in non-palliative specialties, further research should focus on institutionalising supports in these settings.