Serious Illness Conversations (SICs), discussions about values and care preferences for patients with life-threatening illness, rarely occur in Emergency Departments (EDs), despite evidence that early conversations improve care alignment and reduce unnecessary interventions. We interviewed 11 ED providers to identify challenges in SICs and opportunities for technology support, with a focus on AI. Our analysis revealed a four-stage SIC workflow (identification, preparation, conduction, documentation) and barriers at each stage, including fragmented patient information, limited time and space, lack of conversational guidance, and burdensome documentation. Providers expressed interest in AI systems for synthesizing information, supporting real-time conversations, and automating documentation, but emphasized concerns about preserving human connection and clinical autonomy. This tension highlights the need for technologies that enhance efficiency without undermining the interpersonal nature of SICs. We propose design guidelines for ambient and peripheral AI systems to support providers while preserving the essential humanity of these conversations.

翻译：重疾对话（SICs）——关于危及生命患者价值观与照护偏好的讨论——在急诊科（EDs）中鲜少发生，尽管有证据表明早期对话能改善医疗协调性并减少不必要的干预措施。我们访谈了11位急诊科医务人员，以识别SICs中的挑战与技术支持的机遇，重点关注人工智能。分析揭示了SIC工作流的四个阶段（识别、准备、实施、记录）及每个阶段的阻碍因素，包括分散的患者信息、有限的时间与空间、缺乏对话指导以及繁重的记录负担。医务人员对用于信息整合、实时对话支持及记录自动化的AI系统表现出兴趣，但强调需维护人际联系与临床自主权。这一张力凸显了在提升效率的同时不损害SICs人际本质的技术需求。我们提出了环境式与外围式AI系统的设计指南，以支持医务人员的同时保留这些对话的核心人文性。