December 2021

The Unmet Promise of Advance Care Planning

A recent Viewpoint published in JAMA takes a hard look at whether progress has been made in advance care planning (ACP) over the past 30 years since it became proposed as a solution to improving quality of life at the end of life. In “What’s Wrong With Advance Care Planning?” Dr. R. Sean Morrison, Dr. Diane E. Meier, and Dr. Robert M. Arnold, MD, review the promise of ACP, which was developed as an approach to encouraging adults to consider and document their wishes regarding future medical care and who they entrust to ensure that their wishes are carried out should they become unable to speak for themselves. This planning in advance of serious illness was hoped to alleviate the disconnect between what patients want and what ultimately happens during a health crisis. As the authors discovered through a literature review, plenty of evidence shows that end-of-life care and decision making have not improved for patients. The authors outline reasons why the promise of ACP has not been realized, including 8 steps that are essential to its success. They identify the need to reassess how we look at ACP and consider the complexity of factors that exist beyond just putting wishes in writing. Greater use of healthcare proxies is one approach that may help to improve the end-of-life experiences of patients and families. They also call for research into improving training for clinicians to have quality conversations with patients about the goals of clinical care and viewing these conversations as a process.

Hope’s Place in Serious Illness

A recent opinion piece in JAMA highlights the challenge that clinicians face in managing hope in their patients and families experiencing serious illness. In “Holding Hope for Patients With Serious Illness,” Dr. Abby Rosenberg, Dr. Robert M. Arnold, and Dr. Yael Schenker contemplate the tension that exists between encouraging patients to remain hopeful despite a poor prognosis and allowing hope to be diminished for the sake of ensuring understanding of the severity of illness. They discuss the nature of hope, which can take multiple forms and frequently evolves as circumstances change. Research has supported the assertion that fostering hope can provide both psychological and physical benefits for patients. Yet clinicians often express concern that their patients’ hope is indicative of a lack of understanding of their prognosis. 

Clinicians can engage in conversations about hope with their seriously ill patients to help to address the complex nature of hope. These discussions can help to unearth patients’ understanding of their prognosis as well as how their hopes fit within the context of the prognosis. Prompting patients to continue to explore their hopes in deeper ways can allow clinicians to better understand patients’ needs and wishes, leading to more meaningful conversations about potentially conflicting hopes. These conversations can require significant time for clinicians but can ultimately be highly beneficial for patients as they navigate a poor prognosis. The authors conclude, ”Holding complex, flexible, and diverse hopes enables patients to believe in the unlikely while simultaneously accepting the inevitable. The role of clinicians is to support both.” 

The National Summit on Advanced Illness Care

The 2021 Coalition to Transform Advanced Care (C-TAC) National Summit on Advanced Illness Care was held November 8–10 and convened leaders from various disciplines to address core policy issues surrounding the care and support of individuals with serious illness. PA POLST Coalition members Roberta Geidner, MA, Manager, Horizon/Advance Care Planning at WellSpan Health, was part of a pre-summit panel discussion titled “ACP Innovation and the Pandemic: A National Conversation,”  and Emily Jaffe, MD, VP and Executive Medical Director at HM Home and Community Services, Highmark Health, participated in a panel discussion titled “The Intersection of ACP Policy and Practice.” Access the session recordings here through January 31, 2022: https://www.engagez.net/ctacsummit2021#lct=lobby

Coalition for Quality at End-of-Life (CQEL) Meeting

The Coalition for Quality at End-of-Life (CQEL) held its final meeting for the year on Thursday, December 2nd, with a session that featured a talk by Dr. James Joseph and Karen Adams of Geisinger Health System. Their presentation, “myCareChoices: Geisinger’s Approach to Person-Centered Communication,” explored how Geisinger is improving care by focusing on patient–provider communication. Additionally, Dr. Justin Yu of UPMC Children’s Hospital of Pittsburgh presented on “Building Relationships with Black Churches in Pittsburgh.” The meeting also included an update on the POLST curriculum revision project, which was funded by a grant from the McElhattan Foundation. Presentation materials are available upon request. Please contact info@papolst.org for more information. The next CQEL meeting is scheduled for Thursday, February 17th, 2022, from 3:00 pm – 4:30 pm and will feature a discussion about the intersection of advance care planning policy and practice with Dr. Robert Arnold and Dr. Emily Jaffe, moderated by Dr. Alexander Nesbitt.

Tech Webinar on EHRs: How to Advocate for POLST Inclusion in Patient Workflows

‍In this recording of a webinar held on October 12^th, Drs. Matt Gonzales and Ryan Van Wert explore the role EHRs play in POLST technological interoperability, how to advocate for POLST inclusion into EHRs at a system level, and current and potential opportunities for integration with Cerner and Epic systems. (60 min. including questions)

Webinar: Best Practices in Using POLST

‍The National Academy for State Health Policy (NASHP) invited Amy Vandenbroucke (National POLST), Danielle Funk (West Virginia POLST), Cindy Munn (Louisiana POLST), WV Delegate Danielle Walker and Amy Berman (The John A. Hartford Foundation) to present “Best Practices in Using POLST” on October 21st. Amy Vandenbroucke provided an overview of POLST development and current projects; Danielle Funk and Cindy Munn discussed progress in their respective states. Delegate Walker shared her personal story about why end-of-life planning is important. Watch online.

Thank you for your continuing support of POLST.

Judith Black, MD, MHA

National POLST Plenary Assembly

Jewish Healthcare Foundation Medical Advisor

blackjs352@gmail.com

Lisa George, MPH, CHES

PA POLST Coordinator

info@papolst.org

Coalition for Quality at the End of Life (CQEL)

Jewish Healthcare Foundation

EQT Plaza

625 Libery Ave, Ste. 2500

Pittsburgh, PA 15222

412-594-2550

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