Serious Illness Communication in Homecare Nursing: A Concept Analysis

Abstract

Many seriously ill patients receive nursing care at home to manage their illness. There is a growing overlap between homecare and palliative or hospice care. In the homecare setting, nurses may be uncertain about their role and responsibility for engaging in "serious illness communication." The term "serious illness communication" is sometimes used ambiguously, overlapping with other terms such as goals of care discussions or end-of-life conversations. Proponents of serious illness communication emphasize the need for a shift from traditional advance care planning toward a real-time, patient-centered dialogue adaptive to the evolving nature of serious illness. These combined factors highlight the need for further clarification and standardization of the concept, particularly for homecare nurses. The purpose of this project was to analyze the concept of serious illness communication within the context of homecare nursing. A literature review and concept analysis using the method defined by Walker and Avant were performed. A review of the literature highlighted key attributes, including the importance of a relationship focus that is driven by patient values and understanding, is appropriately timed, and incorporates a multidisciplinary team process. This concept analysis discusses the concept and use of serious illness communication as a responsive strategy for meeting a patient's evolving goals and preferences.

Keywords: advance care planning; end-of-life discussions; homecare nursing; hospice care; palliative; serious illness communication.