Talking to Patients about Advanced Care Planning

| Posted On Oct 15, 2014 | By:

Talking to seriously ill patients about their prognosis, the trajectory of their illness, and their treatment options can be a difficult conversation for clinicians to initiate. Patients are also uncomfortable proactively sharing their feelings on the topic with their physician or their families.  Because of the silence, there is typically a big gap between what a patient wants and what actually happens.

According to a Massachusetts Commission on End of Life Care/Massachusetts AARP survey done in 2005, only 17 percent of respondents had spoken with their physician about their healthcare treatment preferences when they are nearing end-of-life. While 70 percent of U.S. respondents to a Centers for Disease Control (CDC) survey said they wished to die at home surrounded by family, in Massachusetts fewer than 25 percent of residents pass away at home, with more than 70 percent spending their final days in hospitals or nursing homes.

Initiatives such as The Conversation Project and Conversation Ready are trying to change this cultural apprehension by providing tools aimed at making us all more comfortable talking about a person’s preferences for care at the end of life so we can be more likely to follow and respect those wishes when needed.

To aid in this process, Atrius Health has created an Advanced Care Planning training program to help our primary care physicians and care team members engage patients in discussions about advance care planning during the normal course of routine care. Our goal is to identify what matters most to patients when considering end of life care and to ensure it is recorded in their medical records and updated as needed over time.

To start, each of the Atrius Health medical groups designated an Advance Care Planning Champion who attended an intensive two day Education in Palliative and End-of-Life Care (EPEC®) Trainer session in Chicago. These Advance Care Planning Champions trained their local PCPs and primary care teams. This training included video presentations, interactive sessions, and role playing to strengthen clinician core competencies in initiating conversations with patients about advance care planning. Each champion acts as a local mentor to other doctors and care team members in their group reminding them of the four core steps of the advance care planning process. These steps include:

  1. Preparing for the discussion by clarifying the patient’s current health status and prognosis
  2. Introducing the concept of advance care planning as routine medical care; discussing options for care in the context of the patient’s current health status & prognosis
  3. Documenting the patient’s goals of care into specific medical orders in the patient’s medical record;
  4. Applying and honoring these goals of care when appropriate and revisiting and revising them in collaboration with the patient as their health status and treatment preferences change.

To date, more than 80% of all the Atrius Health primary care physicians (PCPs), physician assistants, nurses and other care team members have completed advanced care planning training. We have implemented standard work, which includes obtaining a patient’s health care proxy and other advance directive documents prior to or upon arrival at an office visit. We have also enhanced our electronic health record (EHR) to prompt physicians to engage patients in advance care planning conversations and capture all advance care planning documents in one place in a patient’s medical record.

Looking ahead, we will continue our focus on advance care planning for clinicians by:

At Atrius Health, we are committed to having these important conversations and documenting the wishes of our patients so we know their care preferences, and so patients can live the way they want at the end of their lives.

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Comments

  1. Great article! Advanced care planning is so important for patients with a long-term diagnosis. It’s important for patients to have a medical facility where they feel comfortable to ask the medical staff questions. Thanks so much for sharing!

    Comment by Valerie on October 21, 2014 at 9:10 am

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