Conversations at the End of Life: Enhancing Our Clinical Skills

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Conversations at the End of Life Enhancing Our
Clinical Skills

• Geoffrey H. Gordon, M.D.
• Oregon Health Science University
• gordong_at_ohsu.edu

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Presented at Recovering Our Traditions
II Journey to Excellence   A Catholic Health
Care Perspective On End-of-Life Care January
26-28, 2006 San Antonio, Texas
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Sponsored by Supportive Care Coalition Pursuing
Excellence in Palliative Care Catholic Health
Association of the United States The George
Washington Institute for Spirituality and Health
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Outline of Todays Talk

• History of the CEOL program
• Description of the CEOL program
• Demonstration of some video cases
• Dissemination and impact
• Questions and discussion
• CEOL Conversations at the End of Life

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History of the CEOL Program

• Bayer Institute for Health Care Communication
  (now Institute for Healthcare Communication)
  pilots a program at Southern Calif. Permanente
  Medical Group (SCPMG)
• SCPMG had QI initiatives in end-of-life care
• Task Forces in Ethics, Communication, EOL care
• Had goals objectives needed program to
  implement
• Bayer Institute joined with SCPMG to design,
  create, pilot, and produce another program, CEOL

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Kaisers Vision

• Involve all disciplines
• Cover entire spectrum of palliative care
• Very interactive - focus on communication
• 1-hour modules that build on each other but can
  stand independently
• No doom and gloom
• Ready to pilot and launch in 9 months

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CEOL Program Overview

• Six, 1-hour modules and one follow-up
• Brief didactic / discussion
• Interactive skills practice with feedback,
  based on video cases
• Homework apply, reflect
• Workbook with slides, cases, bibliography
• Leaders Guide and Train-the-Trainer course

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CEOL Program Goals

• Review palliative care definition, practices
• Practice related communication skills
• Reflect on our attitudes toward death
• Promote interdisciplinary communication
• Enjoy ourselves in the process

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Pop Quiz Who Said It?

• 1) Im not afraid to die. I just dont want to
  be there when it happens.
• 2) I think we have all lived before and this
  is hell.
• 3) I already died in Altoona.

• A) George Burns
• B) Woody Allen
• C) Lily Tomlin

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CEOL Module Titles

• Defining Palliative Care and a Good Death
• Discussing Advance Care Plans
• Shifting Focus to Palliative Care
• Preparing for a Death
• Managing Family Anger and Distrust
• Resolving Conflict Arising From Cultural
  Differences
• (Follow-up) Talking With Families Whose Job Is
  It?

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Module 3 Objectives

• Shifting Focus to Palliative Care
• Elicit patients and familys perspective
• Elicit concerns without blocking
• Demonstrate empathy
• Describe and prioritize palliative goals
  methods
• Find and pursue common hopes

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Module 3 Schedule

• Lecture Shifting Focus to Palliative Care (20)
• Exercise Practice with video case (35)
• Preparation and video 10
• Interview 5
• Debrief, rewind-repeat 10
• Large group debrief 10
• Closure / Evaluation (5)

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(No Transcript)
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Dissemination of CEOL Program

• Won the Sherman Award for Excellence in CME from
  the California Medical Association in 2001
• Program participants include
• 800 clinicians in Southern and Northern
  California regions of Kaiser Permanente
• 100 clinicians in Providence Health System in
  Portland, Oregon

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Assessing Impact Kaiser

• 103 clinicians at 2 sites had pre, post, 3 mo
  data
• Significant pre-post improvements seen in
• Knowledge
• Importance of communication skills
• Confidence in using the skills
• Changes persisted for 3 months
• Multi-session workshops better than marathon

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Assessing Impact Kaiser

• Clinician self-ratings also improved for
• Intent to express condolences at patient death
• Comfort talking with colleagues about end-of-life
  care
• Satisfaction with providing end-of-life care
• Data on feedback from families is pending

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Consortium Trainees, 2003-2004

• Carondelet Health Network, Tucson, AZ
• Seton Healthcare Network, Austin, TX
• St. Agnes Medical Center, Fresno, CA
• Merry Medical Center, Sioux City, IA
• Providence Health Systems, Portland, OR

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Consortium Work Plans, 2003-2004

• Presentations of modules
• Ethics and Palliative Care Committees
• Palliative care and hospital staff
• Faculty development resident and fellow training
  
• Interdisciplinary training programs
• Networking and collaborating

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Implementing the Program

• Identify leadership sponsors / supporters
• Link to policies and procedures
• Identify resources needed to disseminate program
• Identify effective trainers target audiences
• Tailor materials to the audiences
• Advertise the program broadly

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CEOL Program Components

• Workbook with slides, exercises, bibliography
• PowerPoint slides and video cases
• Leaders Guide with speaker notes, guides to
  arrange workshops, order materials, and advocate
  within your system

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Accessing the CEOL Program

• This package is available from the Institute for
  Healthcare Communication for 350
• Contact information
• Website www.healthcarecomm.org
• Phone [phone]
• Course Director Michael Goldstein, MD at
  mgoldstein_at_healthcarecomm.org

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Match People With Their Last Words

• A) I dont feel good.
• B) Get out of here and leave me alone.
• C) Dont let it end like this. Tell them I
  said something.

• 1) Pancho Villa
• 2) Karl Marx
• 3) Luther Burbank

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Dr. Gordons Contact Information

• Geoffrey H. Gordon, M.D.
• Associate Professor, Medicine and Psychiatry
• Oregon Health Science University
• 3181 SW Sam Jackson Park Road UHN86
• Portland, OR 97239-3098
• [phone] or gordong_at_ohsu.edu