scholarly journals A National Pilot of Goals of Care Conversations for Seriously Ill Veterans: Patient and Site Variation and Associations with Bereaved Family Survey Outcomes (TH323D)

2020 ◽  
Vol 59 (2) ◽  
pp. 422
Author(s):  
Marie Haverfield ◽  
Ariadna Garcia ◽  
Joseph Rigdon ◽  
Karleen Giannitrapani ◽  
Anne Walling ◽  
...  
Keyword(s):  
Goals Of Care ◽  
Site Variation ◽  
Bereaved Family ◽  
Seriously Ill

Pilot of the Life-Sustaining Treatment Decisions Initiative Among Veterans With Serious Illness

2020 ◽  
Vol 38 (1) ◽  
pp. 68-76
Author(s):  
Karleen F. Giannitrapani ◽  
Anne M. Walling ◽  
Ariadna Garcia ◽  
MaryBeth Foglia ◽  
Jill S. Lowery ◽  
...  
Keyword(s):  
Treatment Decisions ◽  
Department Of Veterans Affairs ◽  
Do Not Resuscitate ◽  
Policy And Practice ◽  
Goals Of Care ◽  
Chart Abstraction ◽  
Integrated Health Care System ◽  
Life Sustaining Treatment ◽  
Seriously Ill Patients ◽  
Seriously Ill

Background: Prior to national spread, the Department of Veterans Affairs implemented a pilot of the life-sustaining treatment decisions initiative (LSTDI) to promote proactive goals of care conversations (GoCC) with seriously ill patients, including policy and practice standards, an electronic documentation template and order set, and implementation support. Aim: To describe a 2-year pilot of the LSTDI at 4 demonstration sites. Design: Prospective observational study. Setting/Participants: A total of 6664 patients who had at least one GoCC. Results: Descriptive statistics characterized patient demographics, goals of care, LST decisions, and risk of hospitalization or mortality among patients with at least one GoCC. Participants were on average 71.4 years old, 93.2% male, 87.1% white, and 64.7% urban; 27.3% died by the end of the pilot period. Fifteen percent lacked decision-making capacity (DMC). Nonmutually exclusive goals included to be cured (7.6%), to prolong life (34%), to improve/maintain quality of life (61.5%), to be comfortable (53%), to obtain support for family/caregiver (8.4%), to achieve life goals (2.1%), and other (10.5%). Many GoCCs resulted in a do not resuscitate (DNR) order (58.8%). Patients without DMC were more likely to have comfort-oriented goals (77.3% vs 48.8%) and a DNR (84% vs 52.6%). Chart abstraction supported content validity of GoCC documentation. Conclusion: The pilot demonstrated that standardizing practices for eliciting and documenting GoCCs resulted in customized documentation of goals of care and LST decisions of a large number of seriously ill patients and established the feasibility of spreading standardized practices throughout a large integrated health care system.

scholarly journals Goals-of-Care Consultation Associated With Increased Hospice Enrollment Among Propensity-Matched Cohorts of Seriously Ill African American and White Patients

2020 ◽  
Vol 60 (4) ◽  
pp. 801-810
Author(s):  
Lauren T. Starr ◽  
Connie M. Ulrich ◽  
Paul Junker ◽  
Scott M. Appel ◽  
Nina R. O'Connor ◽  
...  
Keyword(s):  
African American ◽  
Goals Of Care ◽  
Care Consultation ◽  
Seriously Ill ◽  
White Patients

scholarly journals Patient Risk Factor Profiles Associated With Timing of Goals-of-Care Consultation Before Death

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 831-832
Author(s):  
Lauren Starr ◽  
Connie Ulrich ◽  
Paul Junker ◽  
Liming Huang ◽  
Nina O’Connor ◽  
...  
Keyword(s):  
Risk Factor ◽  
Age Groups ◽  
Secondary Analysis ◽  
Regression Tree ◽  
Classification And Regression Tree ◽  
Goals Of Care ◽  
Early Palliative Care ◽  
Palliative Care Consultation ◽  
Care Consultation ◽  
Seriously Ill

Abstract Early palliative care consultation to discuss goals-of-care (“PCC”) benefits seriously ill patients. To identify risk factor profiles associated with inpatient PCC timing before death, we conducted a secondary analysis of seriously ill adults who had PCC at a high-acuity hospital and died 2014-2016. Of 1,141 patients, 54% had PCC “close to death” (0-14 days before death); 26% had PCC 15-60 days before death; 21% had PCC >60 days before death (median 13 days). Classification and Regression Tree modeling showed Hispanic or “Other” race/ethnicity intensive care patients with extreme illness severity (85%) were most likely to have PCC close to death, with age <46 or >75 increasing probability (98%). Among age groups, the highest proportion of patients with PCC close to death was >75 years. Complex variable interactions associated with PCC timing suggests we need a systematic process for initiating PCC earlier and effective primary palliative training for providers across settings.

scholarly journals Delivering More, Better and Earlier Goals of Care Conversations to Seriously Ill Oncology Patients in the Clinical Setting (FR481C)

2016 ◽  
Vol 51 (2) ◽  
pp. 380-381 ◽  
Author(s):  
Joanna Paladino ◽  
Daniela Lamas ◽  
Joshua Lakin ◽  
Samantha Epstein ◽  
Rachelle Bernacki
Keyword(s):  
Clinical Setting ◽  
Oncology Patients ◽  
Goals Of Care ◽  
Seriously Ill

Integrating Palliative Care to Promote Earlier Conversations and to Increase the Skill and Comfort of Nonpalliative Care Clinicians: Lessons Learned From an Interventional Field Trial

2017 ◽  
Vol 35 (1) ◽  
pp. 132-137 ◽  
Author(s):  
Marilyn K. Szekendi ◽  
Jocelyn Vaughn ◽  
Beth McLaughlin ◽  
Carol Mulvenon ◽  
Karin Porter-Williamson ◽  
...  
Keyword(s):  
Palliative Care ◽  
Field Trial ◽  
Care Service ◽  
Supply And Demand ◽  
The United States ◽  
Care Physician ◽  
Lessons Learned ◽  
Service Line ◽  
Goals Of Care ◽  
Seriously Ill

While the uptake of palliative care in the United States is steadily improving, there continues to be a gap in which many patients are not offered care that explicitly elicits and respects their personal wishes. This is due in part to a mismatch of supply and demand; the number of seriously ill individuals far exceeds the workload capacities of palliative care specialty providers. We conducted a field trial of an intervention designed to promote the identification of seriously ill patients appropriate for a discussion of their goals of care and to advance the role of nonpalliative care clinicians by enhancing their knowledge of and comfort with primary palliative care skills. At 3 large Midwestern academic medical centers, a palliative care physician or nurse clinician embedded with a selected nonpalliative care service line or unit on a regularly scheduled basis for up to 6 months. Using agreed-upon criteria, patients were identified as being appropriate for a goals of care conversation; conversations with those patients and/or their families were then conducted with the palliative care specialist providing education, coaching, and mentoring to the nonpalliative care clinician, when possible. All of the sites increased the presence of palliative care within the selected service line or unit, and the nonpalliative care clinicians reported increased comfort and skill at conducting goals of care conversations. This intervention is a first step toward increasing patients’ access to palliative care to alleviate distress and to more consistently deliver care that honors patient and family preferences.

scholarly journals Barriers to Goals of Care Discussions With Seriously Ill Hospitalized Patients and Their Families

2015 ◽  
Vol 175 (4) ◽  
pp. 549 ◽  
Author(s):  
John J. You ◽  
James Downar ◽  
Robert A. Fowler ◽  
François Lamontagne ◽  
Irene W. Y. Ma ◽  
...  
Keyword(s):  
Hospitalized Patients ◽  
Goals Of Care ◽  
Seriously Ill

scholarly journals Changing Culture Around Serious Illness: The VA Life-Sustaining Treatment Decisions Initiative

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 751-752
Author(s):  
Joan Carpenter ◽  
Robert Burke
Keyword(s):  
Treatment Decisions ◽  
Treatment Preferences ◽  
Veterans Health ◽  
Health Administration ◽  
Comfort Care ◽  
Goals Of Care ◽  
Serious Illness ◽  
Wide Range ◽  
Life Sustaining Treatment ◽  
Seriously Ill

Abstract Discussing and documenting goals of care and life-sustaining treatment decisions with seriously ill patients is a widely endorsed practice by healthcare and professional organizations. In 2018, The Veterans Health Administration (VA) initiated a new national policy to standardize such practices, the Life Sustaining Treatment Decisions Initiative (LSTDI), which included a coordinated set of evidence-based strategies and practice standards for conducting, documenting, and supporting high-quality goals of care conversations (GoCCs); staff training to enhance skills in conducting, documenting, and supporting GoCCs; standardized, durable electronic health record tools for documenting patients’ goals and preferences; and monitoring and information technology tools to support implementation and improvement. In this symposium, we will describe the first 20 months of implementing the LSTDI across the VA, the largest integrated healthcare system in the US. The first paper will focus on the factors associated with documentation of a GoCC and treatment preferences. The second paper will present findings describing facilitators and barriers to implementing the LSTDI and identifying factors that promote high rates of LSTDI documentation. The third paper examines patient level outcomes associated with a documented goal of comfort care, specifically the odds of receipt of hospice/palliative care, hospitalization, or ICU admission. This symposium will provide attendees with important information regarding a wide range of individual and system strategies to enhance the care of seriously ill older adults by engaging patients with serious illness in GoCCs and documenting their preferences for treatment in durable, easily accessible notes and orders.

scholarly journals The ‘work’ of managing medications when someone is seriously ill and dying at home: A longitudinal qualitative case study of patient and family perspectives’

2021 ◽  
pp. 026921632110301
Author(s):  
Eleanor Wilson ◽  
Glenys Caswell ◽  
Kristian Pollock
Keyword(s):  
Family Caregivers ◽  
Qualitative Case Study ◽  
Social Constructionist ◽  
Data Sets ◽  
Knowledge Based ◽  
Dying At Home ◽  
Bereaved Family ◽  
Seriously Ill ◽  
At Home

Background: Managing medications can impose difficulties for patients and families which may intensify towards the end of life. Family caregivers are often assumed to be willing and able to support patients with medications, yet little is known about the challenges they experience or how they cope with these. Aim: To explore patient and family caregivers’ views of managing medications when someone is seriously ill and dying at home. Design: A qualitative design underpinned by a social constructionist perspective involving interviews with bereaved family caregivers, patients and current family caregivers. A thematic analysis was undertaken. Setting/participants: Two English counties. Data reported in this paper were generated across two data sets using: (1) Interviews with bereaved family caregivers ( n = 21) of patients who had been cared for at home during the last 6 months of life. (2) Interviews ( n = 43) included within longitudinal family focused case studies ( n = 20) with patients and current family caregivers followed-up over 4 months. Results: The ‘work of managing medications’ was identified as a central theme across the two data sets, with further subthemes of practical, physical, emotional and knowledge-based work. These are discussed by drawing together ideas of illness work, and how the management of medications can substantially add to the burden placed on patients and families. Conclusions: It is essential to consider the limits of what it is reasonable to ask patients and families to do, especially when fatigued, distressed and under pressure. Focus should be on improving support via greater professional understanding of the work needed to manage medications at home.

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