# Train every oncology team in serious-illness conversations and prompt them in the record

Source: https://onco.cc/ideas/idea-acc-serious-illness-conversation-prompts/  
OnCo record `idea-acc-serious-illness-conversation-prompts` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Patients with advanced cancer often never have a clear conversation about what to expect and what matters to them. A structured conversation guide, taught to clinicians and prompted by the record, makes these talks happen earlier.

## Summary

The Serious Illness Care Program (Ariadne Labs) combines clinician training in a structured conversation guide with electronic prompts and documentation. A cluster-randomised trial in oncology showed earlier, more frequent, and more patient-centred conversations and reduced anxiety and depression. Adoption remains limited. Making the programme a standard component of oncology practice would improve goal-concordant care at low cost.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Systematic implementation will raise the proportion of patients with advanced cancer who have a documented goals-of-care conversation before their last month of life from under 40% to above 80%, and reduce non-beneficial intensive care at end of life.
- Rationale: Trial evidence exists; the intervention is training and prompts, which scale cheaply.
- Proposed test: A stepped implementation across a health system with conversation documentation timing, end-of-life care intensity, and bereaved family ratings as endpoints.
- Maturity: being-tested-at-scale
- Actor: clinic

## Sources

- Bottleneck evidence (Pain relief and palliative care are unavailable to most): WHO fact sheet, Palliative care: https://www.who.int/news-room/fact-sheets/detail/palliative-care

## Connected records

- fronts: [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- bottlenecks: [Pain relief and palliative care are unavailable to most](https://onco.cc/bottlenecks/b-palliative/), [Patients lack understanding, navigation and agency](https://onco.cc/bottlenecks/b-patient-voice/)

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