109 Background: Early serious illness conversations (SICs) between oncology clinicians
and patients are associated with improved mood, quality of life, and quality of end-of-life
(EOL) care. Yet, most patients with cancer die without a documented SIC. We report on pre-
specified 40-week SIC and EOL outcomes from a stepped-wedge randomized clinical trial
(NCT03984773) testing the impact of clinician-directed behavioral nudges to prompt SICs
among patients with cancer at high risk of mortality based on a machine learning algorithm …

Importance Serious illness conversations (SICs) between oncology clinicians and patients
are associated with improved quality of life and may reduce aggressive end-of-life care.
However, most patients with cancer die without a documented SIC. Objective To test the
impact of behavioral nudges to clinicians to prompt SICs on the SIC rate and end-of-life
outcomes among patients at high risk of death within 180 days (high-risk patients) as
identified by a machine learning algorithm. Design, Setting, and Participants This …