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

2. The Conversation Project at Erie County Medical Center

3. 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

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

5. 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

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

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

10. 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

11. Conversations with Patients
Remember that the goal is to stimulate authentic dialogue!

12. 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

13. 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

14. 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

15. Take Your Proxy to Dinner Campaign

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

17. Your Voice, Your Values The Conversation Project at ECMC