When the endothelium is on fire: bridging thromboinflammation and data-driven prognosis in pulmonary embolism.

Conversations about a person’s values and goals of care form a foundation that enables clinicians to provide care that meaningfully meets the patient’s and/or family’s needs (; ). Ideally, this type of communication starts at the diagnosis of a serious illness, providing space for clinicians to respond to the patient’s emotions, hopes, and fears, while also exploring the patient’s and/or family’s knowledge and communication preferences (; ). In practice, high-quality communication occurs over time, as an iterative and longitudinal process that adapts to changing preferences or prognosis throughout the patient’s life (). These Serious Illness Conversations (SICs) naturally align with a palliative approach to care, where exploring a person’s values, wishes, and understanding of their illness begins early in the illness journey to ensure that care honors what matters most to the person throughout the course of their illness. The SIC Program is a system-level initiative created by palliative care experts at Ariadne Labs, Massachusetts, USA at Brigham and Women’s Hospital and the Harvard T.H. Chan School of Public Health (; ). It is a multifaceted communication intervention that aims to build clinician capacity for person-centered conversations (). It was designed to better equip clinicians with the ability to communicate and explore topics that matter most to patients and their families as they navigate serious illnesses (; ). The Program is made up of three core components: communication tools (such as the SIC Guide, Patient Pre-Visit Letter, etc.); clinician training; and system change strategies (). SICs facilitate communication and decision-making pathways that have been shown to influence patient, caregiver/family and clinician experiences and outcomes. The SIC Program has demonstrated improvements in oncology care by making information about patients’ goals and values more accessible in the medical record, reducing patient anxiety and depression symptoms, and improving goal-concordant care near end of life (, ; ; ). It has also lowered medical costs in the final months of life (), likely by aligning decisions with patient priorities thereby avoiding unwanted treatment. Use of the SIC Guide enhances patient focus on personal priorities, family communication, and future care (). Clinicians noted that its structured format increases their own confidence to have SICs by offering a safe, practical way to keep track of, explore, and revisit topics that matter to patients and families (). In addition, cultural adaptations of the SIC Guide have increased acceptability among diverse populations (; ), and equity considerations have been examined among patients living with structural vulnerabilities and substance use disorders (; ), revealing promising practices for enhancing access to SICs. Clinicians also benefit from these conversations, reporting greater job satisfaction, stronger communication skills, reduced moral distress, and less anxiety around having these conversations (; ). Overall, the SIC Program is a worthwhile and powerful intervention that aligns with key elements of the Quintuple Aim in healthcare (): enhancing patient experience, reducing costs, improving population health and the work lives of clinicians, and promoting equitable access to high-quality care.