As an organization, we aspire to live up to our guiding principle, “How you want to be treated”, and the serious illness conversations that we have with our patients and residents are one of the ways that we can ensure this is happening. We may be good at these conversations but they aren’t always easy, and we know we need to have them to ensure that our patients and residents are treated how they want to be treated.
More, better, earlier conversations
Recently, the policy that supports Advance Care Planning/Serious Illness Conversations was updated to support staff and physicians in ensuring that we’re not just good at these conversations, we strive to be skillful and we are committed to them. This policy directs us to approach advance care planning and serious illness conversations in a more systematic manner to ensure that no one who should be engaged in this type of conversation is missed.
The purpose of this policy update is to add clarity to the roles and responsibilities of staff and physicians with respect to these conversations taking place at three key stages.
- Stage 1: Proactively encouraging patients/residents as early in their illness as possible.
- Stage 2: By having goals of care conversations with patients/ residents and/or substitute decisions makes (SDM) for persons diagnosed with serious illness.
- Stage 3: By having focused end-of-life conversations with patients/residents and/or SDMs who have been diagnosed with terminal disease or who may be at significant risk of dying within the next 6 to 12 months.
Read the ACP Serious Illness Conversations Policy in full
The updates to the Advance Care Planning/Serious Illness Conversation policy further complements and supports the PHC Options for Care (CPF 1100) and DNAR (CPF 0700) policies in respecting the dignity of the patient/resident as a free and informed decision maker.
Living our values
More, better, earlier conversations is about providing appropriate care to the right person at the right time and knowing what our patients want. Below is information and resources to help support staff and medical staff as we work together to move the dial on engaging in these conversations.
- Options for Care and Resuscitation/DNAR Orders: Updates to these policies, including the information they contain and where they can be found in ChartView were made in April 2017. You can refresh your memory of the details here: http://phcnews.ca/news/updates-options-care-and-advance-care-planning-procedures-providence
- Here to help: We’re here to work with teams and programs to help identify if/where there are opportunities to improve our advance care planning and/or serious illness conversations, provide education, and connect staff with existing resources: Advance Care Planning resources & Serious Illness Conversation Guide resources
- Patient Safety Learning System (PSLS): We’ve had some events reported in PSLS that have helped to shed a light on the circumstances around conversations being missed, not recorded or found when needed. This information gives us insight, and informs our training and resources. We encourage staff to continue to report in when conversations have been missed or the care we have provided has not been concordant with the patient’s previously expressed wishes.
- Accreditation = opportunity: Accreditation season is upon us and your prep work might be a perfect time to reflect on where your program and team are currently at with their conversations, and give you an opportunity to identify the need for training, or a more systematic approach.
Improving conversations is just one of ways PHC is working to increase its operational excellence. When we work together as a team to ensure these conversations are happening, we ensure that no conversation is missed. Ultimately, we do right by our patients and residents, and provide them not only with the care they want but the care they deserve.
Looking for more information?
- Tools & Resources: All Advance Care Planning and Serious Illness Conversations tools and resources can be found here:
Serious Illness Conversation Guide - Clinician Reference
Serious Illness Conversation - Pre-visit Letter
Serious Illness Conversation - Family Communication Guide
Ariadne Labs website also has many helpful resources
- Advance Care Planning brochure: Read and/or print a copy of this recently updated brochure for our patients, residents and families. You can also order additional copies through your program social worker or Patient Health Education Materials (PHEM) at PHEM@providencehealth.bc.ca
- Serious Illness Conversations Guide: The most recent version of PHC’s Serious Illness Guide is attached for reading or printing.
For questions, concerns or more resources, please contact Wallace Robinson, Leader, Advance Care Planning, PHC