How to initiate discussions with healthcare workers about end-of-life care

As Medicare moves to pay doctors for end-of-life discussions with patients, one healthcare institution plans to educate its staff about the importance of palliative care by initiating advance planning discussions with them.

Providence Health & Services,a non-profit Catholic healthcare system based on Renton, Washington, is having advance planning discussions with healthcare providers in all 35 of its hospitals, according to a blog post for NEJM Catalyst by Amy Compton-Phillips, M.D., executive vice president and chief clinical officer at Providence.

End-of-life planning can eliminate wasteful spending and improve the healthcare experience for patients and their families by reducing pain and suffering and the stress of unnecessary measure to prolong life. Providence, wrote Compton-Phillips, "realized we could act even more quickly with our own 80,000 caregivers [employees]."

Providence Health and Services has a self-funded insurance program that has long offered wellness incentives to employees and their families. But  for 2016 enrollment, employees were offered a three-part "alternate educational activity" about end-of-life planning and care. They were invited to:

  • Watch a four-minute video featuring palliative care expert Ira Byock, M.D., the Providence Institute for Human Caring's chief medical officer and a driving force behind the initiative
  • Answer eight reflective questions on end-of-life care
  • Choose a personal plan of action from a range of choices (such as "I will start a conversation with my loved ones about this subject" or "I will update my beneficiaries in my insurance and savings plans") with an option to write in one's own choice

Compton-Phillips reported that 93 percent of caregivers and their spouses who enrolled in 2016 care opted to participate in the end-of-life educational activity. 

Other ways that providers are taking new approaches to end-of-life planning include bringing together caregivers in training and theater students who play the roles of dying patients and their families. 

To learn more:
- read the blog post
- watch the video

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