When one faces a serious illness, "Plan A" is to utilize the powers of modern medicine to try to restore health.
Equally important are the conversations that physicians have with their patients regarding their wishes for everything from symptom control to long-term care planning to help improve their quality of life.
The answers for each of these difficult questions will vary from person to person, and oftentimes, physicians and family members don’t know what’s most important to the patient in these circumstances. In palliative care, we pose these questions to our patients facing serious illness - and the earlier the better - so their wishes are understood long before a crisis occurs.
Physicians outside of palliative care know it’s important to have these discussions, but many have difficulty starting them and aren’t sure what to say, according to a recent national poll. In the U.S., we’re currently faced with a significant shortage of specialty palliative care providers, so it is critical for other medical professionals to also be trained to care for the most seriously ill patients.
A New Palliative Care Program
To improve the care of seriously illpatients and their families, Baylor Scott & White Health is the first health system in the U.S. to implement the Serious Illness Conversation and Care Planning Program, developed by Ariadne Labs, a joint center of Brigham and Women’s Hospital and Harvard T.H. Chan School of Public Health.
The program trains specialists outside of palliative care - family practitioners, internists, cardiologists, oncologists, geriatricians and others who care for seriously ill patients - across the Baylor Scott & White system to have more frequent, better and earlier conversations about their patients’ goals and end-of-life care wishes.
"Serious illness care demands communication expertise, not just at a moment of crisis, but long before a crisis occurs," said Robert Fine, M.D., clinical director of the Office of Clinical Ethics and Palliative Care for Baylor Scott & White. "The Serious Illness Conversation and Care Planning Program allows Baylor Scott & White to take a population health approach to give more patients and families facing serious illness the opportunity to make informed choices that reflect their values, reduce suffering, enhance family well-being and improve their quality of life, even if a cure might not be possible."
￼Patient-centered communication has a positive impact on patient satisfaction and well-being, treatment adherence, self-management of chronic disease and improved outcomes of care.
In February, Atul Gawande, M.D., executive director of Ariadne Labs and author of the bestselling book, Being Mortal, Medicine and What Matters in the End, delivered a keynote address to the Baylor Scott & White community in Dallas to launch the Serious Illness Conversation and Care Planning Program.
"People have priorities and goals besides just living longer," said Dr. Gawande. "The most effective way to learn about these priorities is to ask people. Yet, we ask less than one-third of the time before people die. When we don’t ask, care is not aligned with patient priorities, and the result is suffering.
We chose to collaborate with Baylor Scott & White because of its commitment to being the first system in the country to make sure we ask. Together, we are creating a model of how to transform care and reduce suffering for seriously ill patients notjust for Texas, but for everyone."
Baylor Scott & White is nationally recognized in palliative care. Baylor University Medical Center at Dallas was the first program in Texas - and one of the first 10 in the nation - to receive The Joint Commission’s Advanced Palliative Care Certification in 2012. In 2014, Baylor Health Care System was awarded the American Heart Association’s Circle of Life Award for Best System Level Palliative Care Program.
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