Workshop Overview Understanding Patient Values and Preferences - - PowerPoint PPT Presentation

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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

Understanding Patient Values and Preferences through Goals of Care and Advance Care Planning Conversations Workshop Overview

Reflection Discuss the evidence-based benefits of serious illness conversations Demonstration and debriefing Review of Serious Illness Conversation Guide Role Play (Everyone’s favorite!!)

Reflection – Pair Share

Think of a patient with serious illness who had a bad or good outcome at the end of life in which the outcome was related to communication about goals of care.

Identify the elements of communication (or lack of communication) that you think contributed to the outcome.

Advance Care Planning (ACP)

 "Advance care planning is a process that supports adults

at any age or stage of health in understanding and sharing their personal values, life goals, and preferences regarding future medical care. The goal of advance care planning is to help ensure that people receive medical care that is consistent with their values, goals and preferences during serious and chronic illness." Sudore, JPSM, 2017

 Physicians are poorly trained & most don’t do it  Tend to focus on choices about procedures, rather than

goals, values, and wishes

Hagerty RG et al. J Clin Oncol 2004;22:1721–30.

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ACP is Important

 Most patients have thought about it  Most patients expect you to bring it up  Most patients feel better for having had the

conversation

Wright AA et al. Cancer 2010;116:4656–63. Detering KM et al. BMJ 2010;340:c1345.

Early conversations about patient values and goals linked to better care

• Increased goal-concordant care
• Improved quality of life and patient well-being
• More and earlier hospice care
• Fewer hospitalizations
• Better patient and family coping

Prognosis and ACP

 Given that death may be sudden, is

generally unpredictable, and is often preceded by delirium…

 And given that we are not perfect at

prognosticating….

 We cannot wait until dying is obvious

to have ACP conversations

“Would you be surprised if your patient died within a year or two?”

8/9/2018 3 A FRAMEWORK FOR

BEST

COMMUNICATIO N PRACTICES

Gentle Landings: What can checklists/guides do?

• Bridge gap between evidence and “real world”

implementation

• Assure adherence to key processes
• Achieve higher level of baseline performance
• Ensure completion of necessary tasks during

complex, stressful situations

A conversation with an agenda

SETUP the conversation ASSESS illness understanding & information

preferences

DELIVER patient-centered prognosis

breathe

(pause and respond to emotion)

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ELICIT goals, fears, strengths EXPLORE critical abilities, tradeoffs, family awareness RECOMMEND a way forward

A conversation with an agenda Set Up

introduce the idea ask permission describe the benefits

Assess

illness understanding information preferences

Deliver Prognosis

time function uncertainty

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breathe

(pause and respond to emotion)

Elicit

goals fears strengths

Explore

critical abilities trade-offs family awareness

Recommendation

Summarize Recommend Affirm commitment

8/9/2018 6 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

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Goal Setting

Where to Learn More…

 https://www.ariadnelabs.org/areas-of-

work/serious-illness-care/

 https://portal.ariadnelabs.org/