Your Voice/Your Values Sandra Lauer, RN Kathleen T Grimm, MD June 22, 2017

The Conversation Project at Erie County Medical Center

Erie County Medical Center (ECMC): Located in Buffalo, NY Safety net hospital Most of the population surrounding this hospital are Medicaid recipients/economically depressed area Racially segregated Disparity in end-of-life care Level 1 Trauma Center

Values-Based Conversations Deconstructing The Advance Directive Values-Based Conversations

What makes an effective approach? Advance Care Planning What makes an effective approach? Shift the focus of end-of-life decision making away from document completion and toward facilitating discussion of values and preferences. Do not stress importance of making choices about every possible intervention Provide guidelines for how to make decisions -Institute of Medicine Dying in America Study, 2014

The Conversation Project “We talked about everything except one thing: how she wanted to live at the end of her life". -Ellen Goodman http://theconversationproject.org

Start Conversations early- when people are “people” and not “patients” Conversations should continue throughout a person’s lifetime

The Conversation is NOT about Legal Documents It is about OUR wishes and values It is about family, friends, and loved ones and their understanding and commitment to carry out your end-of-life wishes It may result in important documents

Conversations with Patients Remember that the goal is to stimulate authentic dialogue! http://abcnews.go.com/Health/video/conversation-dr-atul-gawande-17330322

Early conversations about goals of care benefit patients and families Enhanced goal-concordant care Time to make informed decisions and fulfill personal goals Improved quality of life Higher patient satisfaction Fewer hospitalizations Better patient and family coping Eased burden of decision-making for families Improved bereavement outcomes I am happy to provide more data if it would be helpful but let me focus on a few key points… This is true In multiple settings, from primary care to specialty care to intensive care… Mack JCO 2010; Wright JAMA 2008; Chiarchiaro AATS 2015; Detering BMJ 2010; Zhang Annals 2009

ECMC INITIATIVES Build a coalition that includes Palliative peer advocates/Community health workers Activities that are paired with existing activities (health fairs/community group presentations) Partnerships that include pastors/attorneys Leadership buy-in Exemplify the importance ACP within our organization

Normalizing The Conversations It’s not just the elderly or the sick, it’s for young and healthy individuals as well! It’s planning for your future just like you do financial planning, you should plan for how you want to live the remainder of your life It’s a part of wellness Example of one thing we’ve featured for awareness: Partnership with DOD=increased exposure, lots of visitors to our website, downloads of the Conversation Starter Kit We’ll swap these out every few months to highlight some different kind of awareness piece. We might feature a different news article that we’ve been in or an upcoming event so you can see that we’re constantly refreshing our content. Great space for you to add something that you’re doing to spread awareness in your community– examples include a snippet that got featured in the news, a partnership that you have with a local organization, etc. I’d like to pause here for a moment, does any one have ideas of what they might use for these slides? Something interesting in your own community or organization? Feel free to shout them out or type it into the chat. Your Voice, Your Values

Take Your Proxy to Dinner Campaign

I have a healthcare directive not because I have a serious illness, but because I have a family. - Dr. Ira Byock

Your Voice, Your Values The Conversation Project at ECMC