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Northeast Florida Medicine
Vol. 67, No. 1 2016
31
CME
Since the program supports the use of
non-physician facilitators in advance care
planning, what can the physician do to
ensure patients receive the care they want?
Studies have shown that patients age 65 and older, who
discussed advance care planning and directives with their
physician experienced increased satisfaction with that inter-
action.
3
Patients reported less fear and anxiety and believed
that their physicians had a better understanding of their
wishes.These patients continued to discuss their wishes with
their families and these discussions enabled the patients and
families to reconcile differences about end-of-life care.
3
The physician is an important member of the ACP team
and has a significant role to support patients in their desire
and need to have the conversation. It is not realistic to ex-
pect physicians to have the time to provide this service or
participate in a conversation that can take 40 to 90 minutes
depending on the patient and the stage of planning. Facil-
itators guide patients through the conversation and call on
the expertise of the physician when needed. The physician
can help ensure that patient and family decision making is
based on adequate information and understanding.
Physicians play a key role in initiating conversations, moti-
vating their patients to plan, providing medical information
as needed, reviewing plans over time and guiding patients
and decision makers as illnesses progress. When physicians
initiate conversations with patients and families about end-
of-life care, values, goals and preferences, ACP becomes a
part of routine care.This helps normalize conversations about
death, dying and care when a patient is faced with a serious
or life-limiting illness. It is important for physicians to con-
sider the evolving needs of patients approaching the end of
life, which include physical, emotional, social and spiritual
needs of the patient, family and caregivers. End-of-life care
considerations should also include accessing palliative care
specialists when appropriate. Additionally, physicians and
office staff can add questions to office intake forms about
ACP to help initiate discussion. They can also maintain
written information about ACP in the office waiting room
and exam rooms, train to become certified ACP facilitators
and refer patients to Honoring Choices® Florida to schedule
a facilitative conversation about ACP.
Next Steps
The hospitals that participated in the initial implemen-
tation phase are tasked with spreading ACP through their
patient populations. Given the lessons learned, it is critical
to move ACP beyond the walls of the hospitals and into
community settings. Implementation of ACP in other health
care settings such as long term care facilities, assisted living
facilities, continuing care retirement communities, physi-
cian office practices, and home health agencies is underway.
Engagement of leadership and staff in community settings
such as senior centers, councils on aging, religious and
faith-based organizations, universities, community agencies
with a focus on senior services and estate planners and elder
law attorneys is also critical to move ACP upstream, before
people are faced with a serious or life-limiting illness.
Training facilitators based at community sites will help
withACP program implementation. Community education
will foster interest among individuals so they understand
the need for ACP while they are still healthy. Providing
trained facilitators, experienced in guiding what may be a
difficult conversation, is key to the success of new imple-
mentation sites.
Conclusion
Patients want compassionate care that meets their needs
and desires when faced with a serious or life-limiting illness.
However, unless they have talked with their family, health
care team, and others, they may not receive the care desired.
Advance care planning offers the opportunity for a conver-
sation with the goal of documenting an individual’s wishes.
Honoring Choices® Florida is an innovative, results-based
ACP program with the objective of helping individuals
understand, reflect, discuss and document their goals, val-
ues and preferences for care when faced with a serious or
life-limiting illness.
The HCFL website,
HonoringChoicesFL.com, connects
physicians and other communitymembers with information,
tools to establish ACP programs in other settings, and the
opportunity to schedule ACP conversations with trained
facilitators at no cost.
Physicians and other health care providers have the op-
portunity to improve care at the end-of-life, making sure
patients receive the care that they want.
v