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Enhancing the prospects for palliative care at the end of life: A statewide educational demonstration project to improve advance care planning

Published online by Cambridge University Press:  20 June 2016

Debra K. Litzelman ,
Ann H. Cottingham ,
Wilma Griffin ,
Thomas S. Inui  and
Steven S. Ivy
Debra K. Litzelman*
Affiliation:
Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana Health Services Research, Regenstrief Institute Inc., Indianapolis, Indiana Indiana University Health, Indianapolis, Indiana
Ann H. Cottingham
Affiliation:
Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
Wilma Griffin
Affiliation:
Indiana University Health, Methodist Palliative Care, Indianapolis, Indiana
Thomas S. Inui
Affiliation:
Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana Health Services Research, Regenstrief Institute Inc., Indianapolis, Indiana
Steven S. Ivy
Affiliation:
Indiana University Health, Indianapolis, Indiana
*
Address correspondence and reprint requests to: Debra K. Litzelman, Regenstrief Institute Inc., 1050 Wishard Boulevard, RG 5, Indianapolis, Indiana 46202. E-mail: [email protected].
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Abstract

Objective:

Although patients want to participate in discussions and decisions about their end-of-life care, studies show that providers frequently fail to invite them to explore advanced care preferences or goals for living. The purpose of our demonstration project was to provide education and coaching to individuals, health providers, and organizations across the state of Indiana intended to facilitate these conversations, documenting and honoring individuals' life goals and preferences for care during the final stages of life.

Method:

Education and training engaged community members as well as healthcare providers to: (1) improve participant comfort and facility discussing end-of-life issues; (2) improve knowledge of healthcare choices, including palliative and hospice care; and (3) prepare all participants to explore and document personal values, life goals, and priorities as well as goals of care.

Results:

Between January of 2013 and June of 2015, the team educated close to 5,000 participants. Participants' ratings of the quality and perceived usefulness of the educational events ranged from 4 to 5 (using a 5-point scale, with 5 = most effective). Participant comments were overwhelmingly favorable and indicated an intention to put the advance care planning resources, communication skills, knowledge of palliative and hospice care, and personal renewal techniques into practice.

Significance of Results:

Participant motivation to foster advance care planning, discussions of palliative care, and end-of-life conversations was facilitated by the reframing of these conversations as identifying goals of care and priorities for living well during an important stage of life. Successful strategies included helping providers and patients to adopt a broader meaning for “sustaining hope” (not for cure, but for engaging in highly valued activities), developing provider communication skills and comfort in initiating potentially difficult discussions, engaging a new community health workforce who will develop trusting relationships with patients in home-based services, and fostering self-awareness and self-care among palliative care providers.

Keywords

Skill developmentEnd-of-life conversationsProvider self-awareness and self-careCommunity health workersEnd-of-life conversations
Type
Original Articles
Information
Palliative & Supportive Care , Volume 14 , Issue 6 , December 2016 , pp. 641 - 651
Copyright
Copyright © Cambridge University Press 2016 

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