There are a variety of choices people face near the end of life including preferences on pain control, whether to receive palliative care or life-prolonging treatment and perhaps most importantly, choosing a surrogate to make care decisions. While these discussions are often difficult, making treatment preferences known to family and health care providers decreases the chance of unwanted interventions and increases the chance for a greater quality of life.
The Division of Supportive Care at OSF HealthCare launched OSF Care Decisions, an advance care planning (ACP) model that uses trained facilitators to help families have end-of-life care discussions. Jump Simulation, a part of OSF Innovation, assists in training these ACP facilitators how to compassionately discuss the options available to each individual, boosting their knowledge, confidence and competence to handle difficult conversations.
A collaborative Jump research study found that ACP leads to improved documentation of end-of-life wishes, including 24 percent more people choosing a health care power of attorney and eight percent more having a decision on file that helps guide clinicians on resuscitative efforts. ACP was also associated with lower overall costs of care in the last year of life.
“If patients are appropriately referred to palliative care options, it may lead to better pain and symptom relief, less anxiety, less decision stress for families and higher quality of life towards the end of life.”
- William Bond, MD, director of research for Jump.
The Impact of Knowing a Patient’s Wishes
It’s a conversation no one wants to have with their loved ones. If you are at the end of your life and you can’t make decisions for yourself, who would you want to help make decisions for you? Does your surrogate decision maker understand their role? Do they understand what you as a person would want? Have you expressed your goals of care when faced with severe chronic illness or when a cure is not possible?
The Division of Supportive Care at OSF HealthCare has been offering the OSF Care Decisions program since 2008, an advance care planning (ACP) model that uses trained facilitators to help people discuss future health care decisions with their families and providers. This includes completing the necessary paperwork to designate a Health Care Power of Attorney (HCPOA) and filling out a Provider Orders for Life Sustaining Treatment (POLST) form which helps guide resuscitative efforts if patients are near the end of their life.
The idea is to decrease the chance of unwanted interventions and increase the chance for a greater quality of life. More than 4000 Advance Care Plans take place throughout the Ministry every year. Jump Simulation, a part of OSF Innovation, helps train ACP facilitators, most of whom are nurses or social workers, to ensure they have the knowledge, confidence and competence to discuss care options with individuals and their families.
ACP Simulation Training
A Jump study published in the Journal of Palliative Medicine in 2017 found ACP simulation training to be instrumental in positively shaping facilitators for ACP. 71 percent of learners felt the ACP simulation program met their expectations “to a great extent.” Their knowledge scores increased from 83 percent to 92 percent. Following the training, facilitators who underwent simulation also averaged 3.87 ACPs per month, a 121 percent increase from FY 2014.
The research team for Jump recently released another study in 2018 showing the impact of this work.
“We are involved in the training of the facilitators who sit down with people and have these discussions. We wanted to find out the downstream impact of this simulation training. These facilitators are doing this important service; what’s the outcome?”
- William Bond, MD, director of research for Jump.
What are the Benefits of ACP?
Information gathered from an ACP session can include answers to a variety of questions families may face if they are left to make health care decisions for their loved ones. Among them include preferences on pain control, whether to receive palliative care or life-prolonging treatment and perhaps most importantly, choosing a surrogate to make care decisions.
The Jump research team compared the patient charts of 325 deceased patients who went through ACP with 325 of those who did not go through the ACP process to determine whether they had a HCPOA designated and if they had POLST forms on file in the last 12 months of life.
The study found that 98.5 percent of patients who completed ACP chose a HCPOA while only 75 percent of those without ACP made this designation. Meanwhile 53 percent of patients who went through ACP had POLST forms on file while 45 percent of those without ACP had completed the forms. Using Accountable Care Organization (ACO) data for OSF HealthCare, the research also found those who had ACP had fewer in-patient admissions and in-patient days. ACP was associated with overall costs that were $9500 lower.
“When you factor in all of the costs of the ACP facilitation program, including the simulation-based training, there was still a savings of more than $4800 per patient,” said Lisa Barker, MD, Director of Education at Jump.
The study was published in the December 2017 issue of the Journal of Palliative Medicine and was a collaborative effort between team members from Jump Simulation, Healthcare Analytics at OSF HealthCare, the Division of Supportive Care at OSF HealthCare, the Center for Outcomes Research at the University of Illinois College of Medicine Peoria and Illinois Wesleyan University.