Case Study: Advance Care Conversations

Jim Molpus, for HealthLeaders Media , May 17, 2013

Physicians are trained to be direct and scientific, which may lead them to ask blunt questions of the patient, such as, "What do you want me to do if your heart stops?" Hammes says. Most patients are not emotionally equipped to make that leap, so the conversations start with finding common ground.

"You start out by asking if they have ever been in a situation where someone in their family or a close friend had serious medical problems and someone else had to make decisions for them," Hammes says. "And almost every patient has some story to tell about when [their] grandma died and there was a lot of conflict in the family."

The facilitators flip the question around and ask the patients what they learned from that experience and how it may help them in their own illness, Hammes says.

"Probably for the first time they say, 'Oh, well, I guess what I learned is that when families don't have these conversations in advance that things could really go wrong and it can really lead to a lot of unnecessary distress.' You're not lecturing to them. You have personalized it."

After the patient is engaged in the idea of having the conversation, the facilitators can get more specific, Berra says. "It starts with the patient talking about their understanding of their disease and what's happening with them right now. How has it changed their life? What are the complications they can expect or know about? What are their hopes for their treatment? So the nature of the conversation starts at a level that they are pretty comfortable with and then moves them into what might not be as comfortable."

In cancer care, for example, the facilitators ask patients about their understanding of their cancer, their goals and values or faith and experiences, and then go into specific scenarios that may happen as a result of their disease. "So it helps the patient talk about their illness," Berra says. "The conversation clarifies goals, values, and choices. It also helps the person the patient has chosen to make medical choices for them."

Reprint HLR0513-10

This article appears in the May issue of HealthLeaders magazine.

Jim Molpus is Leadership Programs Director of HealthLeaders Media.
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