8/9/2018 Workshop Overview Understanding Patient Values and Preferences through Goals of Care and Reflection Advance Care Planning Conversations Discuss the evidence-based benefits of serious illness conversations Demonstration and debriefing Review of Serious Illness Conversation Guide Role Play (Everyone’s favorite!!) B R O O K C A L T O N M D , M H S A S S I S T A N T P R O F E S S O R O F C L I N I C A L M E D I C I N E U N I V E R S I TY O F C A L I F O R N I A , S A N F R A N C I S C O Reflection – Pair Share Advance Care Planning (ACP) "Advance care planning is a process that supports adults Think of a patient with serious illness who at any age or stage of health in understanding and sharing their personal values, life goals, and preferences had a bad or good outcome at the end of regarding future medical care. The goal of advance care life in which the outcome was related to planning is to help ensure that people receive medical communication about goals of care. care that is consistent with their values, goals and preferences during serious and chronic illness." Identify the elements of Sudore, JPSM, 2017 communication (or lack of Physicians are poorly trained & most don’t do it communication) that you think Tend to focus on choices about procedures , rather than contributed to the outcome. goals, values, and wishes Hagerty RG et al. J Clin Oncol 2004;22:1721 – 30. 1
8/9/2018 Early conversations about patient values ACP is Important and goals linked to better care • Increased goal-concordant care Most patients have thought about it • Improved quality of life and patient well-being Most patients expect you to bring it up • More and earlier hospice care Most patients feel better for having had the • Fewer hospitalizations conversation • Better patient and family coping Wright AA et al. Cancer 2010;116:4656–63. Detering KM et al. BMJ 2010;340:c1345. Mack JCO 2010; Wright JAMA 2008; Chiarchiaro AATS 2015; Detering BMJ 2010; Zhang Annals 2009 Prognosis and ACP Given that death may be sudden, is “Would you be surprised generally unpredictable, and is often preceded by delirium… if your patient died And given that we are not perfect at within a year or two?” prognosticating…. We cannot wait until dying is obvious to have ACP conversations 2
8/9/2018 Gentle Landings: What can checklists/guides do? A FRAMEWORK FOR • Bridge gap between evidence and “real world” BEST implementation COMMUNICATIO • Assure adherence to key processes N • Achieve higher level of baseline performance PRACTICES • Ensure completion of necessary tasks during complex, stressful situations A conversation with an agenda breathe SETUP the conversation ASSESS illness understanding & information preferences DELIVER patient-centered prognosis (pause and respond to emotion) 3
8/9/2018 A conversation with an agenda Set Up introduce the idea ELICIT goals, fears, strengths EXPLORE critical abilities, tradeoffs, family awareness ask permission RECOMMEND a way forward describe the benefits Assess Deliver Prognosis time illness understanding function information preferences uncertainty 4
8/9/2018 Elicit goals breathe fears strengths (pause and respond to emotion) Explore Recommendation Summarize critical abilities Recommend trade-offs Affirm commitment family awareness 5
8/9/2018 Key Points Video Demonstration Patient is... • 68 year-old retired married salesman • Advanced COPD on oxygen and steroids, diabetes, kidney disease, chronic hip pain • 3 hospitalizations, multiple rehab stays this year, 2 ER visits • Experiencing: - Worsening shortness of breath - Increasing fatigue and weakness - Worsening functional status and 10 lb weight loss • Here for an outpatient appointment after an admission https://www.youtube.com/watch?v=fhwa9f5O_U4 Time to Practice 6
8/9/2018 Where to Learn More… Goal Setting https://www.ariadnelabs.org/areas-of- work/serious-illness-care/ https://portal.ariadnelabs.org/ 7
Recommend
More recommend
