Using Nurse Care Managers Trained in the Serious Illness Conversation Guide to Increase Goals-of-Care Conversations in an Accountable Care Organization

Lally, Kate; Fulton, Ana Tuya; Ducharme, Constance M.; Scott, Ruth M.; Filpo, JoAnn

doi:10.1089/jpm.2019.0110

Cited by 16 publications

(14 citation statements)

References 5 publications

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“… Staff = 61 31 (50.8%) Routinely informing hospitalists when their patients were identified as being at increased risk for unmet palliative needs did not increase the sense of meaning these providers achieved. Lally et al (2020) [ 41 ] U.S. We undertook a project to increase the number of SICs occurring in an ACO using a script delivered telephonically by nurse care managers. Quality improvement implementation.…”

Section: Table A1mentioning

confidence: 99%

Patient Identification for Serious Illness Conversations: A Scoping Review

Baxter

Fromme

Sandgren

2022

IJERPH

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Serious illness conversations aim to align medical care and treatment with patients’ values, goals, priorities, and preferences. Timely and accurate identification of patients for serious illness conversations is essential; however, existent methods for patient identification in different settings and population groups have not been compared and contrasted. This study aimed to examine the current literature regarding patient identification for serious illness conversations within the context of the Serious Illness Care Program and/or the Serious Illness Conversation Guide. A scoping review was conducted using the Joanna Briggs Institute guidelines. A comprehensive search was undertaken in four databases for literature published between January 2014 and September 2021. In total, 39 articles met the criteria for inclusion. This review found that patients were primarily identified for serious illness conversations using clinical/diagnostic triggers, the ’surprise question’, or a combination of methods. A diverse assortment of clinicians and non-clinical resources were described in the identification process, including physicians, nurses, allied health staff, administrative staff, and automated algorithms. Facilitators and barriers to patient identification are elucidated. Future research should test the efficacy of adapted identification methods and explore how clinicians inform judgements surrounding patient identification.

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Section: Table A1mentioning

confidence: 99%

Patient Identification for Serious Illness Conversations: A Scoping Review

Baxter

Fromme

Sandgren

2022

IJERPH

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“…[44][45][46] For all patients, QoL is uniquely personal and grounded in what gives one's life meaning by naming health priorities/ tradeoffs. 47 For PC clinicians, improving QoL often means addressing symptoms and anticipating changes in health status while monitoring risks associated with treatments and disease progression. 27 In SUD treatment, goal setting, and QoL discussions are person-centered discussions that assess readiness to change substance use while respecting goals ranging from no change to reducing use or to not using at all.…”

Section: Attention To Quality Of Lifementioning

confidence: 99%

Adapting Palliative Care Skills to Provide Substance Use Disorder Treatment to Patients With Serious Illness

Jones

Sager

et al. 2021

Am J Hosp Palliat Care

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Background: The majority of Palliative Care (PC) clinicians report recently caring for a person with a Substance Use Disorder (SUD). The impact of an untreated SUD is associated with significant suffering but many PC clinicians report a lack of confidence in managing this population. Objective: This paper aims to demonstrate existing PC skills that can be adapted to provide primary SUD treatment. Methods: A comprehensive literature review was conducted on quality PC domains and core SUD treatment principles. To demonstrate the shared philosophy and skills of PC clinicians and SUD treatment, the National Consensus Project Clinical Practice Guidelines for Quality Palliative Care and resources outlining core Addiction Medicine and Nursing Competencies were used. Results: There is an abundance of overlapping domains in PC and SUD treatment. This paper focuses on the domains of communication, team-based care, quality of life considerations, addressing social determinants of health, and adherence to ethical principles. In each section, the shared domain in PC and SUD treatment is discussed and steps to expand PC clinician's skills are provided. Conclusion: PC clinicians may be among the last healthcare touchpoint for persons with SUD, by naming the shared skills required in PC and evidenced-based SUD treatment, we challenge the field to undertake primary SUD treatment as part of its constant pursuit to better serve people living with serious illness.

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“…Diverse initiatives promoting such conversations include elements of communication training to physicians, physician trainees, and advanced practice providers 1,9,10 and expanded training to nurses and lay health workers. [11][12][13][14][15] Efforts to expand diverse providers' and community roles in goals of care initiatives are associated with improved patient quality of life and outcomes. 10,11,16,17 The importance of involving diverse providers in implementing goals of care is underscored by the challenges that have been described in conducting such conversations.…”

Section: Introductionmentioning

confidence: 99%

“…[18][19][20][21][22][23] These barriers have been mitigated by empowering and equipping interdisciplinary providers to conduct goals of care conversations. [11][12][13][14][15] Although this strategy has been a feature of research efforts, better understanding is needed on how to successfully expand the roles of interdisciplinary providers in pragmatic contexts.…”

Section: Introductionmentioning

confidence: 99%

Exploring expanded interdisciplinary roles in goals of care conversations in a national goals of care initiative: A qualitative approach

et al. 2021

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Background: The United States Veterans Health Administration National Center for Ethics in Health Care implemented the Life-Sustaining Treatment Decisions Initiative throughout the Veterans Health Administration health care system in 2017. This policy encourages goals of care conversations, referring to conversations about patient’s treatment and end-of-life wishes for life-sustaining treatments, among Veterans with serious illnesses. A key component of the initiative is expanding interdisciplinary provider roles in having goals of care conversations. Aim: Use organizational role theory to explore medical center experiences with expanding interdisciplinary roles in the implementation of a goals of care initiative. Design: A qualitative thematic analysis of semi-structured interviews. Setting/participants: Initial participants were recruited using purposive sampling of local medical center champions. Snowball sampling identified additional participants. Participants included thirty-one interdisciplinary providers from 12 geographically diverse initiative pilot and spread medical centers. Results: Five themes were identified. Expanding provider roles in goals of care conversations (1) involves organizational culture change; (2) is influenced by medical center leadership; (3) is supported by provider role readiness; (4) benefits from cross-disciplinary role agreement; and (5) can “overwhelm” providers. Conclusions: Organizational role theory is a helpful framework for exploring interdisciplinary roles in a goals of care initiative. Support and recognition of provider role expansion in goals of care conversations was important for the adoption of a goals of care initiative. Actionable strategies, including multi-level leadership support and the use of interdisciplinary champions, facilitate role change and have potential to strengthen uptake of a goals of care initiative.

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Using Nurse Care Managers Trained in the Serious Illness Conversation Guide to Increase Goals-of-Care Conversations in an Accountable Care Organization

Cited by 16 publications

References 5 publications

Patient Identification for Serious Illness Conversations: A Scoping Review

Patient Identification for Serious Illness Conversations: A Scoping Review

Adapting Palliative Care Skills to Provide Substance Use Disorder Treatment to Patients With Serious Illness

Exploring expanded interdisciplinary roles in goals of care conversations in a national goals of care initiative: A qualitative approach

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