Please select the eligibility criteria that correspond to the clinical trial below.
Title: Serious Illness Communication Project
Brief Summary: The purpose of the study is to evaluate the impact of implementing a "Serious Illness Conversation Guide" to guide patient/family-clinician discussions and planning about end-of-life care decisions. The goal of the intervention is to improve achievement of patient care priorities and peacefulness at the end of life for patients with serious and life-threatening illness and their families. We hypothesize that patients whose physician is trained to use and adheres to the elements of the Serious Illness Conversation Guide will demonstrate enhanced consistency between documented key priorities and care received, and will experience greater peace in the final month of life; similarly, their families will experience higher satisfaction with care.


Options:
A: Inclusion Criteria:

* Survivors: Latina, has been diagnosed with breast cancer, speaks English or Spanish, has a Caregiver who is willing to participate.
* Caregivers: a primary caregiver for a Latina breast cancer survivor, speak English or Spanish

Exclusion Criteria:

1. Inability to understand spoken English and/or Spanish and/or
2. Cognitive impairment that precludes informed consent (determined by the PIs or Co-Investigators who are mental health professionals).
B: Inclusion Criteria: Physicians

* Currently in clinical practice at participating institutions
* Oncologist that cares for patients with solid tumors
* Not planning to leave the practice during the next 6 months

Inclusion Criteria: Patients

* Currently a patient of an enrolled physician
* Age 21 years or older
* Diagnosis of advanced cancer
* Able to understand spoken English (study personnel will read materials to low literacy patients)

Inclusion Criteria: Caregivers

* Caregiver of a patient currently enrolled in the study
* Age 21 years or older
* Able to understand spoken English (study personnel will read materials to low literacy patients)

Exclusion Criteria: Physicians

* Non Physicians and physicians who are not oncologists
* Oncologists who exclusively care for patients with hematological malignancies
* Prior involvement in health-related coaching interventions

Exclusion Criteria: Patients

* Unable to complete orally-administered surveys in English
* Hospitalized or in hospice care at the time of recruitment
* Prior involvement in health-related coaching interventions
* Anticipating bone marrow transplantation or diagnosed with leukemia or lymphoma

Exclusion Criteria: Caregiver

Unable to complete orally-administered surveys in English
C: The subjects of this study will be the clinicians (physicians and nurse practitioners) conducting the SICG conversations, their patient with high-risk cancers, and a friend or family member of the patient.

Clinician Inclusion Criteria:

1. Dana-Farber Cancer Institute medical oncology clinician
2. Care for patients with selected high-risk cancers

Clinician Exclusion Criteria:

1. DFCI Gynecology-Oncology specialist
2. Seeing patients only in the Phase I clinical trial disease center

Patient Inclusion Criteria

1. Over 18 years of age
2. English speaker
3. Patient at Dana-Farber Cancer Institute, including satellite sites at Milford Regional Medical Center and South Shore Hospital
4. Diagnosis of one of the following high mortality or advanced cancers: breast, gastric, intestinal, esophageal, pancreatic, biliary, colorectal, hepatocellular, head and neck, renal, bladder, prostate, acute myeloid lymphoma (AML), acute lymphoblastic lymphoma (ALL), lymphoma, melanoma, glioblastoma multiforme (GBM), sarcoma, and lung.
5. Ability to provide consent

Patient Exclusion Criteria

1. Diagnosis of advanced obstetric-gynecological cancer
2. Cognitive impairment

Family Member Inclusion Criteria

1. Over 18 years of age
2. English speaker
3. Friend or family member of study patient (Health care proxy, or close friend or family member who is involved in helping the patient think about decisions related to their health care)
4. Ability to provide consent
D: Inclusion Criteria:

Physician:

* all internal medicine residents at either University of Washington (UW)or the Medical University of South Carolina
* who have a clinical rotation allowing implementation of the intervention.

NP Student:

* All NP Students at UW or MUSC
* in programs that train them to work with the following patient types:
* Adult patents with Cancer or other chronic, life-limiting illnesses
* Older Adults
* Adults Primary Care Patients

Patient:

One or more of the following diagnostic criteria:

* Advanced Cancer;
* Chronic obstructive pulmonary disease (COPD) with FEV1 values \< 35% predicted and/or oxygen dependent;
* Restrictive lung disease with a TLC \< 50% predicted;
* Congestive heart failure with an ejection fraction \<30% or functional deficits matching New York Heart Association Class III or IV heart failure;
* End stage liver disease including Child's Class C cirrhosis, MELD score ≥ 18, a variceal bleed, refractory ascites, or spontaneous bacterial peritonitis (SBP);
* a Charlson Comorbidity Score point value ≥6;
* in-patients with a University HealthSystem Consortium (UHC) Risk of Mortality score of major or extreme;
* OR hospitalized patients ≥ 80 years.

Family:

* The ability to speak English well enough to be able to complete the study procedures
* AND no significant dementia or delirium that would limit the family member's ability to complete instruments.

Nurse-evaluators:

* are working in the hospital or clinic with the resident or NP student enrolled in the study.

Exclusion Criteria:

* less than 18 years,
* significant dementia, delirium, or psychosis;
* the inability to speak English well enough to be able to complete the study procedures.

Answer: C