Advance care planning helps with tough conversations

April 16 is Healthcare Decisions Day. While no one wants to tackle the subject of their own mortality, we find that embracing the discussion can reduce stress for family members when a health crisis hits. Chris Brinneman, MSW, LCSW, manager, Advance Care Planning, explains how Parkview Health is introducing new advanced care planning facilitators and helping walk patients and coworkers through the process.  
 
What influenced Parkview’s decision to really focus on advance care planning?

A few years ago, while attending various conferences, some of our family practice doctors started hearing about advance care planning (ACP), and the value of talking to patients about their health care wishes. At the same time, the palliative care team identified that there were many challenges in just starting to have conversations about patient wishes and the goals of care when the patient was in the hospital, trying to cope with a serious illness. A small group met and agreed that Parkview Health needed to figure out a way to start having advance care planning conversations with healthier adults, helping them to explore how their goals, values, and cultural, religious, spiritual and personal beliefs might impact future healthcare decision making. We had our first wave of ACP implementation go live in May 2017.

How did Parkview develop the program?

After exploring current ACP practices and programs being implemented in other communities, we chose to work with Respecting Choices®, an internationally recognized, evidence-based model for advance care planning. With guidance from our Respecting Choices® consultant, the newly created ACP department began working with an executive steering committee and targeted work groups to design and implement advance care planning here at Parkview Health. We chose to start small but think big, making plans to roll out advance care planning in waves over time to make sure our processes worked for all and were sustainable over time and location. We now have 65 providers/co-workers who are certified advance care planning facilitators.

Why is ACP so important?

Ultimately, we, healthcare providers, cannot respect a person’s choices for future medical care unless we know what they are. Most of us will face advanced illness at some time – our own or a loved one’s. Yet, historically, healthcare systems and care team members have waited for a patient to initiate this kind of discussion or we have tried to start a discussion when a patient is critically ill, in crisis, lying in an intensive care bed. We’ve certainly had times when it was too late to ask about a patient’s choices, because the patient was no longer able to make healthcare decisions and their family members and providers did not know what the patient’s wishes really were.

Who should participate in ACP?

ACP is important for all adults, regardless of age or health, and is part of routine, standard care. ACP conversations, led by a trained facilitator, can result in the completion of advance directive documents. Advance directive documents allow a person to state instructions about future medical care and treatment and to appoint someone to make healthcare decisions when that person is unable to communicate his/her own choices. Effective ACP can better ensure that patients receive medical management that matches their identified goals. ACP is truly a gift people can give to their families. Having ACP conversations has been shown to increase patient/family satisfaction, lower moral distress and lead to healthier bereavement.

In addition to inviting the people we serve to have ACP conversations, we’ve invited co-workers to participate in having their own personalized ACP conversations.

What are some of the hurdles to these conversations and how can people work through them?

Contemplating our own mortality and having preparatory conversations about future illness and death is a rarity in our society. Historically, healthcare providers often waited for the patient to start conversations about future healthcare decision making. They’ve taken a passive approach to initiating these discussions, unsure that the timing is right, uncertain what is culturally appropriate for the patient, and hesitant to give a patient the impression that they are giving up on them. However, since we have implemented ACP within the health system, a majority of patients have agreed to participate in having ACP conversations, with a satisfaction rating of 4.9/5. Normalizing that ACP is for all adults, reinforcing the value for the patient, families and providers, and reminding people that over time all adults will be invited to participate can all lead to patient engagement related to ACP. Many times, the people who end up needing ACP the most are the people who expected to need it the least.

For more on advance care planning, contact Chris Brinneman, ACP Manager, at chris.brinneman@parkview.com, (260) 266-1471 or Amy Spallinger, First Steps Organizational Faculty, at amy.spallinger@parkview.com, (260) 266-6246. You can find several advance directive documents on our website to start the dialogue.

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