Serious Illness Conversations in the Emergency Department for Older Adults With Advanced Illnesses: A Randomized Clinical Trial

PMCID: PMC12177648

PMID: 40531532

DOI: 10.1001/jamanetworkopen.2025.16582

Journal: JAMA network open

Publication Date: 2025-6-18

Authors: Ouchi K, Block SD, Rentz DM, Berry DL, Oelschlager H, et al.

Key Points

• Nurse-led ED intervention increased clinician-documented serious illness conversations without significant patient-reported engagement
• Clinician documentation of SICs increased from 9.9% at baseline to 31.4% in the intervention group at 6 months
• ED visits represent an underutilized opportunity for initiating advance care planning discussions for older adults with serious illnesses

Summary

This randomized clinical trial investigated the effectiveness of a nurse-led intervention to discuss serious illness care goals in the emergency department (ED) for older adults with advanced illnesses. The study enrolled 141 patients, comparing an intervention group receiving targeted serious illness conversations (SICs) with a control group. While patient-reported engagement in advance care planning (ACP) did not significantly improve, the intervention notably increased clinician-documented serious illness conversations in medical records over 6 months.

The research highlights the ED as a potentially critical access point for initiating serious illness discussions among clinically stable older adults with advanced conditions. The intervention demonstrated a statistically significant increase in clinician documentation of SICs, particularly at the 3-month (p=.03) and 6-month (p=.008) follow-up periods, suggesting that structured nursing interventions can facilitate important end-of-life care conversations.