Kalmakis, KarenPark, HyeyoungManz, ChristopherHanley, Samantha C.2024-10-222024-10-222024-05https://hdl.handle.net/20.500.14394/55011Background: Conversations about end-of-life (EOL) preferences decrease usage of aggressive medical care at EOL, facilitate earlier hospice enrollment, and improve quality of life for cancer patients. Serious illness conversations (SICs) are coordinated conversations between oncology clinicians and cancer patients about illness understanding, goals and worries, care preferences, prognosis if desired, etc. Despite previous attempts to increase SIC rates at an academic cancer center, engagement remained low. A quality improvement (QI) clinical trial was ongoing to increase SICs and improve EOL outcomes for advanced cancer patients, but preliminary data revealed a continued gap. A review of the literature revealed a dearth of evidence exploring patient-perceived barriers to engaging in SICs. Purpose: The purpose of this Doctor of Nursing Practice (DNP) capstone project was to identify the barriers to engagement in SICs among advanced cancer patients, caregivers, and oncologists to enhance the next iteration of a QI effort. Methods: The DNP student conducted semi-structured interviews with 19 advanced cancer patients and 10 caregivers. Brief surveys were completed by 15 oncologists caring for 17 of the 19 patients interviewed. Analysis involved qualitative content analysis and descriptive statistics. Results: The most common barrier theme was patient characteristics, specifically lack of readiness, followed by clinicians and disease. The most common facilitator was clinicians, specifically comfortable rapport. SIC nudges involving personal touch were preferred over automated messaging. Conclusion: Several QI suggestions were made based on the thematic analysis of patients’, caregivers’, and oncologists’ perceptions of barriers and facilitators to SIC.Attribution-NonCommercial-NoDerivatives 4.0 Internationalhttp://creativecommons.org/licenses/by-nc-nd/4.0/barriersserious illness conversationpalliative care conversationcancermalignancyambulatoryCapstone Project