To evaluate the feasibility of implementing a coordinator-facilitated Serious Illness Care Programme (SICP) in outpatient oncology, cardiology and palliative medicine clinics.

Single-arm, mixed-methods, prospective feasibility study conducted over three sequential phases across 9 months, guided by the Reach, Effectiveness, Adoption, Implementation, Maintenance framework.

Outpatient oncology, cardiology and palliative medicine clinics in two tertiary medical centres in Singapore.

Eleven clinicians (eight doctors and three nurses) participated. Clinicians had prior serious illness conversation (SIC) training and were purposively sampled for diversity in specialty, seniority and mode of care delivery. One participant disengaged midway due to concerns about intervention fit but completed endline measures. A total of 101 patients participated in an SIC during the intervention period.

Implementation supports were developed with reference to the Capability, Opportunity, Motivation–Behaviour model of behaviour change, and adapted to the workflows and needs of participating clinicians. These included email reminders, in-person prompting by a coordinator, access to a locally adapted SIC guide, a structured documentation template and optional patient preparation materials. Supports were introduced in full during phase 2, with in-person prompting and support withdrawn in phase 3.

Feasibility was the primary outcome, operationalised through clinician perceptions of implementation support (acceptability) and the proportionality of implementation effort to observed benefits (practicality). Secondary outcomes included SIC engagement rates (reach), clinician retention (adoption) and continuity intentions among clinicians (maintenance).

Clinician retention was 91% (n=10/11) with the only dropout being in the cardiology setting. Most clinicians felt support was acceptable and adequate (n=9/11). While 101 patients had SICs, engagement activity in oncology and cardiology declined following the withdrawal of in-person prompting, while engagement among palliative medicine clinicians remained stable or increased. Coordinator time commitment decreased by 75.8% between phases 2 and 3. Key barriers faced by clinicians included the documentation burden. Additionally, there was a perceived lack of fit in outpatient cardiology.

A coordinator-facilitated SICP is feasible and acceptable in outpatient oncology and palliative care settings. Active coordination reduces clinician burden. As in-person prompting may be necessary to sustain engagement in non-palliative specialties, further research should focus on institutionalising supports in these settings.

To adapt the Serious Illness Conversation Guide (SICG), Ariadne Labs, Massachusetts USA, to a local Singapore version and evaluate its acceptability.

Qualitative study using semistructured interviews.

49 participants (30 patients with serious illnesses, five family caregivers and 14 healthcare providers (HCP)) recruited from three public hospitals in Singapore.

Face-to-face or virtual indepth interviews.

Guided by the Heuristic Framework and Cultural Sensitivity model, we employed a multi-stage iterative design. Starting with the original SICG, we iterated the guide following three rounds of cognitive interviews among patients followed by expert consultation (n=4) to derive a local version, subsequently reviewed by caregivers and HCP. We assessed acceptability of the SICG using traffic light colour codes—red (unacceptable), orange (needs change) and green (no change) and gathered suggestions to rephrase them. Using content analysis, we compared acceptability of questions as proportion of red, orange and green responses at each interview round and inductively derived themes reflecting views towards the guide.

The original SICG showed low acceptability, and most questions received high proportions of red responses. Negative words and phrases dampening hope, lack of comprehension due to complex framing and cultural insensitivity to prognostic discussions were key themes reflecting low acceptability. Surface and deep structural revisions that centred around positive framing with hopeful language, focusing on current values and individualising conversations (‘use if appropriate’ prompts) significantly improved the guide’s acceptability.

We derived a local Singapore SICG that aligns with the core elements of the original guide and fosters cultural sensitivity. The adapted version could be further tested in other Asian countries.