Work

Vocational Awe is (not) Enough: Learnings From Early Adopters of Serious Illness Communication

Year: 2025

Type: article

Abstract: CONTEXT: As part of a broader institutional initiative, the serious illness care program was implemented in a multisite academic primary care practice. After 2 years, a minority was observed to be documenting serious illness conversations routinely. OBJECTIVES: We aimed to learn about the motivations and actions of clinicians who routinely conducted and documented serious illness conversations. METHODS: We identified primary care early adopters of serious illness communication: 17 of 228 physicians (roughly 8%) who were documenting at least 1-2 conversations every 1-2 months for a year. Fifteen physicians agreed to participate in semi-structed interviews and which were then analyzed with thematic analysis. RESULTS: Early adopters successfully integrate serious illness conversations into clinical practice by using four strategies that amplify vocational awe: their deep sense of their professions core value. Three strategies focus on positive aspects of serious illness communication: (1) reflecting on the meaningful impact of serious illness conversations on clinical care; (2) feeling a resonance between serious illness communication and their identity and values; and (3) identifying with the medical community's sense that serious illness communication contributes to good clinical care. The fourth strategy is to minimize system limitations using a range of tactics that include accepting time shortages and streamlining workflow. CONCLUSION: Vocational awe is a powerful driver for engaging in serious illness communication; however, without system-level resource support, it does not sustainably motivate most clinicians. Serious illness communication needs to be a part of routine healthcare with appropriately allocated time, compensation, and workflow support.

Source: Journal of Pain and Symptom Management

DOI: 10.1016/j.jpainsymman.2025.05.006

Authors: Patrick Malecha, Alexis Drutchas, Jenny Klintman, Elizabeth Lindenberger, Juliet Jacobsen

Institutions: Beth Israel Deaconess Medical Center, Harvard University, Massachusetts General Hospital, Lund University, Region Skåne

Language: English

Topic: Palliative Care and End-of-Life Issues

Subfield: Public Health, Environmental and Occupational Health

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $4,760