1. By the end of this session, learners will be able to identify at least one strategy for improving serious illness conversation encounters with family caregivers in the long-term acute care setting 2. By the end of this session, learners will be able to describe qualitative strategies for studying serious illness communication notes documented in the electronic health record of a long-term acute care setting The prolonged management of critical illnesses in long-term acute care hospitals (LTACHs) makes palliative care interventions, such as serious illness communication (SIC), an imperative. SIC in the LTACH is onerous because healthcare providers often lack training and patients are typically unable participate, making caregivers the center of these interactions. This study characterized caregiver engagement in SIC encounters in the year following a SIC healthcare provider training in an LTACH. SIC notes documented in the electronic health record were qualitatively analyzed using an a priori coding framework and open coding in NVivo. Before thematic analysis, the codes were grouped according to an SIC quality context, which considered two underlying features of the encounter: evidence of prognostic understanding and documented treatment preferences. This resulted in four contexts, SIC with prognostic understanding and documented preferences, prognostic understanding but undocumented preferences, a lack of prognostic understanding but documented preferences, or a lack of prognostic understanding and undocumented preferences. Across 125 patient cases, 251 SIC notes were analyzed. Most patients were admitted for respiratory failure (79%), and caregivers were typically spouses or adult children (69%). Four manifestations of caregiver engagement emerged. In the highest-quality context (prognostic understanding and documented preferences) caregivers were engaged in SIC as upholders of patients' wishes. With prognostic understanding but undocumented preferences, caregivers tended to be deferrers of healthcare decision making. In the opposing context (lack of prognostic understanding, documented preferences), caregivers were searchers, intent on treatment options. Under poor circumstances (lack of prognostic understanding and undocumented preferences), conflict emerged, where caregivers were instigators of disagreements with the healthcare team or family. These findings underscore the important influence of the SIC quality context on caregiver engagement in SIC. These findings should be considered in priming SIC interactions in a way that meets the caregivers' needs and facilitates healthcare decision making. [ABSTRACT FROM AUTHOR]