Seriously ill patients cannot always choose their health outcomes, but they can have a say in the journey. The time to prepare a patient for what is coming is early in the course of their illness, but those conversations are not easy for physicians, patients or their families and caregivers. Research has shown we need a “language” to facilitate the communication.
One solution to that communication roadblock is the Serious Illness Conversation Guide – a way to help physicians safely talk about end-of-life issues without removing health or hope. Evidence shows that early care planning improves goal-concordant care, reduces anxiety for families and caregivers, improves access to hospice care and reduces unwanted invasive care (Bernacki, JAMA, 2014).
Alberta has a group of health care professionals who are committed to sharing this tool. Dr. Jessica Simon is the division head for the Division of Palliative Medicine, Department of Oncology, at the University of Calgary Cumming School of Medicine, a physician consultant for advance care planning and goals of care, and a physician for palliative and end-of-life care.
Sarah Hall is a project director for the AHS Edmonton Zone Integrated Quality Management team who leads its Advance Care Planning/Goals of Care Designation Working Group and Serious Illness Conversation Guide courses.
Dr. Elisa Mori-Torres is a passionate advocate for future care planning using the PATH protocol out of Halifax and the SICG. She is an Assistant Professor in Family Medicine at the University of Alberta, graduated from the Care of The Elderly U of A program and is Past Co-Chief of Geriatrics at Glenrose Rehabilitation Hospital. She is currently doing hospice and community work with complex, frail, end stage elderly, where SICG is vital for developing comprehensive value-oriented care plans.
“The guide is designed to help physicians talk to patients about their illness, its natural course and the impact of proposed treatments,” says Sarah. “It really changes the conversation from what is happening to the patient to what matters to the patient.”
The guide helps facilitate the important conversations patients should be having at the most difficult time in their lives. The guide helps to accomplish the following:
- Build physician awareness and acceptance of what matters most to their patients.
- Bring family and close friends into the care conversation.
- Ensure those important conversations happen before patients begin to decompensate.
- Make the patients’ wishes known so their loved ones are not guessing about what should be done.
The power is in individual stories
The Serious Illness Conversation Guide course consists of three video learning modules and a role-playing component. The stories told in those videos are moving.
One particularly powerful story is told by a young woman who lost both her dad and her stepdad to cancer within a few months’ time. Her stepdad had a physician who encouraged open dialogue and seemed in tune with his patient’s wishes for the time he had left. Her mom also learned how to make it okay for her stepdad to talk about his wishes. When he passed, his family was with him, and as sad as it was, his death was beautiful.
Her dad’s experience was quite the opposite. He was a private person, and he was not very open about the struggles of his illness. His medical appointments focused on treatments, but not how he was coping with the rest of his life. There were no conversations beyond the medically necessary ones. At the end, when they rushed him to the hospital, he was in so much pain that he needed to be heavily medicated. They never even got to say goodbye.
Earn Mainpro+ credits
The full Serious Illness Conversation Guide course is being offered via Zoom. It has been certified by the College of Family Physicians for up to 7.0 Mainpro+ credits. To register:
- North Zone: email IQM.Connection@ahs.ca
- South Zone: email Calgaryconversations.matter@ahs.ca
Learn more about the conversations that matter
www.conversationsmatter.caResources on advance care planning and goals of care designations in Alberta
Serious Illness Care Program Demos
An introduction to the Serious Illness Conversation Guide from the creators of the guide at Ariadne Labs
Reference:
Communication About Serious Illness Care Goals A Review and Synthesis of Best Practices, Rachelle E. Bernacki, MD, MS; Susan D. Block, MD
Published Online: October 20, 2014. doi:10.1001/jamainternmed.2014.5271.
Banner image credit: Mohamed Hassan, pixabay.com