Background Primary care providers recognize the importance of ACP conversations and their role in having them. PCP’s report barriers to having these conversations that include not having adequate training, not knowing what to say, not having enough time and patient-family member conflict.1 for ACP to succeed, better clinician communication skills are necessary.2 Conversations of a Lifetime® (COL), a Hospice of Cincinnati program and part of the TriHealth system, combined multiple evidence-based modalities to initiate ACP in 36 TriHealth primary care practices.
Respecting Choices Advanced Steps® curriculum for RN care managers to identify appropriate patients, facilitate conversations, and serve as a resource in completing advance directives.
VitalTalk® developed a custom coaching curriculum for physicians to feel more confident about initiating ACP conversations.
Electronic Medical Record (EMR) enhancements:
ACP Summary Report
ACP Best Practice Alert
An ACP Nurse Liaison provided technical support to optimize workflows and EMR documentation.
Results ACP conversations initiated and documented increased in 36 primary care practices with a combination of communication coaching, staff training, RN technical support and EMR enhancements (Intervention period: May 2014 – Dec 2016; 7,199 conversations). ACP conversations sustained (Post-Intervention period: Jan-Dec 2017; 7,589 conversations).
Conclusion By combining two complementary, evidenced-based curricula, providing support of a nurse liaison and designing a summary and alert in the EMR, this program exceeded its goal to initiate 2,000 ACP conversations in primary care. Other health systems might consider a similar multicomponent intervention to increase ACP.
References 1. Perry Undem Research/Communication. Physicians’ Views Toward Advance Care Planning and End-of-life Care Conversations. Johnhartford.org [Internet]. 2016 Apr [cited 2017 Feb 23]: [28 pages]. Available from: http://www.johnahartford.org/images/uploads/resources/ConversationStopper_Poll_Memo.pdf.
2. Bernacki RE, Block SD: Communication about Serious Illness Care Goals: A Review and Synthesis of Best Practices. JAMA Intern Med 2014;174:1994–2003.
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