Goals of care program: Psychosocial opportunities in the ICU

2010 ◽  
Author(s):  
Matthew Loscalzo ◽  
David Horak ◽  
Marie Malicki ◽  
Tana Burns ◽  
Ben Laroya ◽  
...  
Keyword(s):  
Care Program ◽  
Goals Of Care

Delivering more, earlier, and better goals-of-care conversations to seriously ill oncology patients.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 39-39 ◽  
Author(s):  
Rachelle Bernacki ◽  
Joanna Paladino ◽  
Daniela Lamas ◽  
Mathilde Hutchings ◽  
Josh Lakin ◽  
...  
Keyword(s):  
Chart Review ◽  
Systematic Approach ◽  
Care Program ◽  
Cluster Randomized Trial ◽  
Patient Centered ◽  
Goals Of Care ◽  
Serious Illness ◽  
Clinician Training ◽  
Patient Values

39 Background: Patients with serious illness routinely receive treatments that are not aligned with their goals. Earlier clinical conversations about patients’ values and priorities lead to more goal-concordant care and improved quality of life, but these conversations often happen too late or not at all. The Serious Illness Care Program has designed a systematic approach to train and support clinicians in conducting more, earlier, and better conversations about goals of care with their patients. Objectives: Evaluate clinician adoption and acceptability of the training program and the Serious Illness Conversation Guide; determine the frequency, timing, and quality of goals of care documentation before death. Methods: Cluster-randomized trial including oncology clinicians and their patients. Intervention: clinician identification of high risk patients; 2½ hour clinician training on the Serious Illness Conversation Guide; email trigger/reminder; EMR documentation. Preliminary chart review to extract goals-of-care conversations for deceased patients in intervention and control. Results: 90 oncology clinicians: 47 intervention; 43 control. Of 47 intervention clinicians, 46 are trained and rate the training as effective (4.3/5). 97% of trained clinicians who have been triggered have adopted the Conversation Guide and find it acceptable (4.2/5). 342 patients enrolled: 176 intervention; 166 control; 38% have died (n = 131). A preliminary chart review revealed more goals-of-care conversations occurred before death in intervention compared to control (92% versus 70%, p = 0.0037); intervention conversations took place four months earlier than control (median 143 days versus 63 days, p = 0.0008). In addition, conversations were more patient centered (95% versus 45%, p < 0.001) and more readily retrievable in the EMR (68% versus 28%, p < 0.001). Conclusions: Preliminary data about the Serious Illness Care systematic approach demonstrate strong clinician adoption and acceptability. The intervention results in more, earlier, and better conversations about patient values and priorities, in addition to more patient-centered and retrievable documentation of goals of care in the medical record. Clinical trial information: NCT01786811.

Goals of care discussion and hospice enrollment.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 229-229
Author(s):  
Annika Gustafson ◽  
Mallika Sharma ◽  
Tracy Wong ◽  
Keith D. Eaton
Keyword(s):  
Cancer Patients ◽  
Care Setting ◽  
Hospice Care ◽  
Care Program ◽  
Healthcare Setting ◽  
Outpatient Setting ◽  
Provider Type ◽  
Goals Of Care ◽  
Hospice Referral ◽  
Wish To Die

229 Background: When asked, many people wish to die at home. Yet, more than one third of cancer patients with poor prognosis die in hospital. Enrollment in hospice care is associated with reduced receipt of high-intensity care toward the end of life. Hospice is palliative care tailored to patients in the last 6 months of life. The ability to collect, organize, analyze and report documented Goals of Care (GOC) conversation data and the relationship to hospice enrollment is challenging. Seattle Cancer Care Alliance (SCCA) created a process to establish a sample baseline of documented GOC discussions, the healthcare setting in which they took place, and how this relates to hospice enrollment. Methods: We selected a sample of 50 decedent charts. Patients were verified as period of 6 months from date of death, documenting provider type, care setting that documented discussion took place and chart search terms. Results: Our sample consisted of 50 adult solid tumor cancer patients who died between March-May 2018. Using an SCCA created GOC discussion definition adapted from Ariadne Labs Serious Illness Care program, we found that 52% of patients had a GOC discussion in the last 6 months of life and of these, 92% discussed hospice with a provider, 77% received a hospice referral and 62% enrolled in hospice. 48% of our decedent sample did not have a GOC discussion. 46% had a hospice discussion of whom 100% enrolled in hospice. 46% received a hospice referral. 54% of patients did not discuss hospice of whom 30% enrolled in hospice. In looking at which providers talked with patients about hospice and in what care setting, we found that 44% discussed hospice with outpatient medical oncologist, 10% discussed hospice with an outpatient provider, 16% had a discussion while inpatient, and 30% had no hospice discussion at all. Conclusions: The majority of GOC discussions happened in the outpatient setting with medical oncologists. Many patients never had a discussion about hospice with their provider. Patients were most likely to enroll in hospice when it was specifically discussed, regardless of whether a GOC discussion took place.

Much Ado About Fried Chicken: Abetting Aspiration or Respecting Autonomy?

2019 ◽  
Vol 28 (3) ◽  
pp. 1356-1362
Author(s):  
Laurence Tan Lean Chin ◽  
Yu Jun Lim ◽  
Wan Ling Choo
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Multidisciplinary Team ◽  
Biopsychosocial Model ◽  
Family Members ◽  
Clinical Decisions ◽  
Goals Of Care ◽  
Complex Needs ◽  
Aspiration Risk ◽  
Patient Centric

Purpose Palliative care is a philosophy of care that encompasses holistic, patient-centric care involving patients and their family members and loved ones. Palliative care patients often have complex needs. A common challenge in managing patients near their end of life is the complexity of navigating clinical decisions and finding achievable and realistic goals of care that are in line with the values and wishes of patients. This often results in differing opinions and conflicts within the multidisciplinary team. Conclusion This article describes a tool derived from the biopsychosocial model and the 4-quadrant ethical model. The authors describe the use of this tool in managing a patient who wishes to have fried chicken despite aspiration risk and how this tool was used to encourage discussions and reduce conflict and distress within the multidisciplinary team.

Internet addiction recovery after-care program development research

2013 ◽  
Author(s):  
Yeo-Ju Chung ◽  
Sungman Shin ◽  
Do Hyung Lee ◽  
Ji Yun Kim ◽  
Su Jung Ryu ◽  
...  
Keyword(s):  
Program Development ◽  
Internet Addiction ◽  
Care Program ◽  
Development Research ◽  
Addiction Recovery ◽  
After Care
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