更早且更频繁地与患者进行严肃疾病对话可以让临床团队更好地将医疗护理与患者的目标和价值观对齐。非医师临床医生通常具有独特的视角和对患者意愿的理解，因此非常适合支持与严重病患者的对话。斯坦福大学的团队重症护理计划旨在涉及所有护理团队成员，以支持并开展与患者及其看护者和家人的严重疾病对话。我们采访了临床医生，以了解护理团队如何实施团队为基础的方法来进行严重疾病对话并应对产生的团队复杂性。我们采用了快速定性方法来分析两个团队为基础的SICP实施组（住院肿瘤科和医院医学）（n = 25）的半结构化临床医生和行政利益相关者的采访。分析得出了框架/理论：跨学科角色协议、团队形成和运作以及组织理论。实施基于团队的SICP是可行的。主题1集中在团队如何形成和管理以达成一致：快速更改人员/责任的团队优先考虑沟通，而人员/责任保持一致的团队主要依靠协议。主题2说明了多层次的领导和管理者可以支持实施。主题3探讨了优势和机会。积极的是，基于团队的SICP分配了工作负担，根据患者需求及时进行对话，并从非医师团队成员中增加了独特的价值。角色不明确和冲突归因于沟通不良和伦理冲突。基于团队的严重疾病沟通是可行和有价值的，具有成功的工作流和领导方法。版权©2023 Elsevier Inc. 发布。

Earlier and more frequent serious illness conversations with patients allow clinical teams to better align care with patients' goals and values. Non-physician clinicians often have unique perspectives and understanding of patients' wishes and are thus well-positioned to support conversations with seriously ill patients. The Team-based Serious Illness Care Program (SICP) at Stanford aimed to involve all care team members to support and conduct serious illness conversations with patients and their caregivers and families.We conducted interviews with clinicians to understand how care teams implement team-based approaches to conduct serious illness conversations and navigate resulting team complexity.We used a rapid qualitative approach to analyze semi-structured interviews of clinician and administrative stakeholders in two Team-based SICP implementation groups (i.e., inpatient oncology and hospital medicine) (n=25). Analysis was informed by frameworks/theory: cross-disciplinary role agreement, team formation and functioning, and organizational theory.Implementing Team-based SICP was feasible. Theme 1 centered on how teams formed and managed to come to agreement: teams with rapidly changing staffing/responsibilities prioritized communication, whereas teams with consistent staffing/responsibilities primarily relied on protocols. Theme 2 demonstrated that leaders and managers at multiple levels could support implementation. Theme 3 explored strengths and opportunities. Positively, Team-based SICP distributed work burden, timed conversations in alignment with patient needs, and added unique value from non-physician team members. Role ambiguity and conflict were attributed to miscommunication and ethical conflicts.Team-based serious illness communication is viable and valuable, with a range of successful workflow and leadership approaches.Copyright © 2023. Published by Elsevier Inc.