Project: Serious illness care program – Kronobergsmodellen

In order for patients with serious illness to be offered care based on their preferences and the possibility for families to live a good life, new ways of working needs to be developed. Ariadne Labs in Boston has developed “The Serious Illness Care Program” with focus on physician-led conversations. As the only region in Sweden, Region Kronoberg implemented an adapted version of this for specialist physicians at several units in 2018 through the project “Serious illness conversations - Kronobergsmodellen 1.0”. This was done in collaboration with Centre for Collaborative palliative Care (Linnaeus University/Region Kronoberg) and Institute for Palliative Care in Lund (Lund University/Region Skåne). The organization, as well as our research at Centre for Collaborative Palliative Care, now highlight the need to expand this model to also include nurses, with focus on team collaboration and the need to clarify the implementation process to create sustainable structures in the organization.

The aim of the project is to expand, adapt, implement and evaluate a new innovative, structured way of working “Seriuos illness conversations -Kronobergsmodellen 2.0”. This way of working includes conversations with focus on identifying and meeting the needs of patients and their families so that they can live a good life with serious illness. Earlier research has focused on so-called ‘breaking point conversations’, which are often offered late in the disease trajectory, when the patients have deteriorated and mainly to patients with cancer. Our project enables conversations earlier in the trajectory, regardless of diagnosis. The conversations serve as tools to provide a care and treatment based on the patients’ and families’ needs, goals and priorities as well as strengths and resources.

To initiate a conversation at an early stage with patients and families concerning prognosis, diagnosis, and goals and preferences relating to future care does not only increase the participation, it has also been shown to reduce anxiety and improve quality of life for patients and families.

‘Serious illness conversations – Kronobergsmodellen’ includes a structured way of working with several different steps; for example, one-day conversation training for both physicians and nurses together with actors based on a structured dialogue guide, identification of patients, offering conversations to patients, documentation in medical records, follow-up of conversations, mentorship for physicians and nurses, as well as falicitators during the implementation.

During the period 2021–2024, the expanded Kronobergsmodellen 2.0 will be implemented at several units. The research will be conducted by Center for Collaborative Palliative Care in collaboration with Ariadne Labs, USA. There is also international collaboration on the model with researchers in the USA, UK, and Spain.

The project focuses both on the implementation and the effects of the model. Translation and validation of a number of guides and instruments is being carried out. A pilot study is being conducted to expand, test and evaluate Kronobergsmodellen 2.0, after which it will be implemented at three units with three control units. Process evaluation will continuously focus on implementation, context, change mechanisms and outcomes; at baseline, 3 and 12 months. Quantitative and qualitative methods will be used, focusing on e.g. impact on patients’ and families’ life situation, conversational skills and health economic factors.

The project is a unique project in Swedish healthcare through its focus on both implementation and effects of new ways of working in an entire organization. It also highlights the importance of team collaboration and involves both physicians and nurses, where previous interventions have focused on one profession. The fact that all diagnoses are included is also unique. The project focuses on that the patients’ and families’ preferences should guide the care.