{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T05:54:17Z","timestamp":1781502857114,"version":"3.54.1"},"reference-count":36,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100001349","name":"National Medical Research Council","doi-asserted-by":"publisher","award":["SEEDFD23jul-003"],"award-info":[{"award-number":["SEEDFD23jul-003"]}],"id":[{"id":"10.13039\/501100001349","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Palliat\ufffdCare"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study aimed to identify how contextual, dispositional, and relational factors intersect to shape the participant experience of serious illness conversations (SICs) while exploring the nuances of appraisal across different clinical specialties.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A convergent parallel mixed-methods study was conducted as part of a Serious Illness Care Programme pilot at two Singaporean tertiary centres. Participants with advanced cancer or heart failure were recruited from oncology, cardiology, and palliative medicine clinics. We conducted semi-structured interviews and a Patient Experience Survey (PES) that explored participants views on their communication experience. .Qualitative data were analysed via a case-based thematic approach. Findings were summarized by coders into experience categories of \u201cGood,\u201d \u201cModerate,\u201d or \u201cPoor.\u201d Quantitative comparisons between patient-reported PES scores and coder-assigned ratings were performed using the Kruskal-Wallis rank-sum test.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Forty participants were recruited (33 patients, 7 caregivers), with 32 (26 patients, 6 caregivers) completing interviews, and 24 patients completing the PES. Among interviewed patients, 19 had advanced cancer and 7 had heart failure. While 96% of patients rated their SICs as \u201cmostly\u201d or \u201cextremely\u201d worthwhile in the PES, qualitative analysis revealed a complex landscape of acceptance, ambivalence, and distress. Discrepancies between patient-reported and coder-assigned ratings indicated that participants appraised encounters as \u201cWorthwhile\u201d even when experiencing significant distress. Four themes were identified as primary influences on participant experience: subjective illness understandings, clinician conversational practices, personal readiness, and relational dynamics. The analysis suggests that trust established through longitudinal therapeutic relationships functioned as a buffer against negative appraisals, offer a possible explanation for why \u201cWorthwhile\u201d scores remained largely experience-invariant.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study demonstrates that SIC acceptability is a dynamic appraisal refracted through subjective illness understandings and relational contexts. Future research should investigate specific communicative mechanisms that foster affective readiness and rapport, ensuring that serious illness communication aligns with, rather than disrupts, patient and caregiver expectations of healthcare communication.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/26323524261460927","type":"journal-article","created":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T14:51:09Z","timestamp":1781275869000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["What makes serious illness conversations acceptable? A mixed-methods study of patient and caregiver experiences in oncology and cardiology"],"prefix":"10.1177","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-0735-9595","authenticated-orcid":false,"given":"Alston","family":"Ng","sequence":"first","affiliation":[{"name":"National Cancer Centre Singapore"},{"name":"Duke-NUS Medical School"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Su-Min","family":"Yeo","sequence":"additional","affiliation":[{"name":"National Cancer Centre Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2811-1661","authenticated-orcid":false,"given":"Shirlyn Hui-Shan","family":"Neo","sequence":"additional","affiliation":[{"name":"National Cancer Centre Singapore"},{"name":"Duke-NUS Medical School"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,6,12]]},"reference":[{"key":"e_1_3_8_2_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2019.0077"},{"key":"e_1_3_8_3_2","doi-asserted-by":"publisher","DOI":"10.3390\/curroncol29030128"},{"key":"e_1_3_8_4_2","doi-asserted-by":"publisher","DOI":"10.1200\/JOP.19.00765"},{"key":"e_1_3_8_5_2","doi-asserted-by":"publisher","DOI":"10.1200\/EDBK_431352"},{"key":"e_1_3_8_6_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2022.6303"},{"key":"e_1_3_8_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2024.10.034"},{"key":"e_1_3_8_8_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12885-019-5333-x"},{"key":"e_1_3_8_9_2","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.140673"},{"key":"e_1_3_8_10_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12875-020-01167-0"},{"key":"e_1_3_8_11_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-019-4209-8"},{"key":"e_1_3_8_12_2","doi-asserted-by":"publisher","DOI":"10.1017\/S1478951522001298"},{"key":"e_1_3_8_13_2","article-title":"Serious Illness Conversations in advanced kidney disease: a mixed-methods implementation study","volume":"17","author":"Thamcharoen N","year":"2021","unstructured":"Thamcharoen N, Nissaisorakarn P, Cohen RA, et al. Serious Illness Conversations in advanced kidney disease: a mixed-methods implementation study. BMJ Support Palliat Care 2021; 17: bmjspcare-2020-002830. https:\/\/doi.org\/10.1136\/bmjspcare-2020-002830","journal-title":"BMJ Support Palliat Care"},{"key":"e_1_3_8_14_2","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2016.0485"},{"key":"e_1_3_8_15_2","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2018.0487"},{"key":"e_1_3_8_16_2","doi-asserted-by":"publisher","DOI":"10.1111\/ecc.13537"},{"key":"e_1_3_8_17_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2019.0292"},{"key":"e_1_3_8_18_2","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2020.0680"},{"key":"e_1_3_8_19_2","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2019.0437"},{"key":"e_1_3_8_20_2","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2023.0681"},{"key":"e_1_3_8_21_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.330.7498.1007"},{"key":"e_1_3_8_22_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjspcare-2016-001286"},{"key":"e_1_3_8_23_2","doi-asserted-by":"publisher","DOI":"10.1002\/ehf2.12941"},{"key":"e_1_3_8_24_2","doi-asserted-by":"publisher","DOI":"10.7861\/clinmedicine.10-4-339"},{"key":"e_1_3_8_25_2","doi-asserted-by":"publisher","DOI":"10.1080\/2159676X.2019.1704846"},{"key":"e_1_3_8_26_2","doi-asserted-by":"publisher","DOI":"10.22374\/cjgim.v17i1.528"},{"issue":"6","key":"e_1_3_8_27_2","first-page":"468","article-title":"Experience implementing the serious illness care program through virtual training of multidisciplinary teams at a regional cancer centre","volume":"33","author":"Leong R","year":"2025","unstructured":"Leong R, Andreychuk S, Shoemaker C, et al. Experience implementing the serious illness care program through virtual training of multidisciplinary teams at a regional cancer centre. 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