Adaptations to the Serious Illness Conversation Guide to Be More Culturally Safe

Abstract

The Serious Illness Conversation Guide (SICG) has been shown to be an effective communication tool used by health care professionals when interacting with patients facing a life-limiting illness. However, Ariadne Labs, the originators of the tool, have not tested it with First Nations and Indigenous Peoples. In this project, the British Columbia Centre for Palliative Care and the First Nations Health Authority in British Columbia (BC), Canada collaborated to adapt the SICG to be more culturally safe for First Nations and Indigenous Peoples. Multiple feedback strategies were employed. Feedback was received from 35 older adults, Elders, and community members from two First Nations communities plus approximately 80 nurses serving in First Nations communities across BC. Key areas of focus for feedback on the clinical tool included setting up the conversation, involving family, closing the conversation, and using principles of health literacy to reduce power differences. Three questions were added in response to feedback received. By creating a safe space for dialogue, it is hoped that health care providers and family members will develop a deeper understanding of what is important to the person with a life-limiting illness. These conversations promote patient-centred health care that aligns with patient values and wishes. Findings from this project directly informed modification of the tool to support a more culturally safe conversation. Further research will inform whether this tool is culturally safe for all seriously ill people.