09:14pm Monday 17 February 2020

End-of-life planning

By Ryann Nickerson | University Communications

A study out of the University of Colorado College of Nursing at the Anschutz Medical Campus has examined advance-care planning for congestive heart failure and shown a lack of clear triggers alerting providers to when it’s time to begin end-of-life discussions. 

“The study findings shed light on an alternate way to look at the future, beyond the way doctors and other professionals have talked about it,” said Jacqueline Jones, PhD, associate professor at the CU College of Nursing (at right).

Earlier this month, the Centers for Medicare and Medicaid Services proposed a rule that would reimburse doctors for talking about advance care planning, which will go into effect in January. While doctors are trained to maintain health and fight illness, they do not receive much guidance or incentives on how to communicate with dying patients and their caregivers. The researchers hope the study will increase the frequency of discussions between providers and patients to better understand their preferences about end-of-life care planning.

The study suggests key transition points for when to introduce and discuss such planning. It’s critical to know how much a patient understands their disease before beginning the conversation.

When first diagnosed, many patients and caregivers shared that “because it’s so new, I don’t even know what questions [about the future] to ask my doctor.” The study said providers should encourage a patient to appoint a surrogate, educate the patient about forms of life support, and begin an ongoing discussion about the patient’s general goals of care and life plan. As the disease progresses, the conversation evolves to how they live with the disease and eventually how and where a patient wants to die.

Providers can use the following four transition points to frame the illness trajectory and inform advance care planning discussions with heart failure patients:

  • When a patient is first diagnosed – a diagnosis of congestive heart failure is confusing and difficult to absorb.
  • The future as “coming to terms with and learning to adjust to life” with heart failure.
  • Owning their future, reframing and taking back control of one’s life.
  • Understanding and accepting that death is inevitable.

According to the study, many physicians have little or no training in end-of-life conversations. Researchers found that cross-discipline providers can help physicians hone the skills required to have these discussions with patients suffering chronic illness.

The article, “The Future as a Series of Transitions: Qualitative Study of Heart Failure Patients and Their Informal Caregivers,” was originally published in the February 2015 issue of the Journal of General Internal Medicine. M. Jane Markley, RN, MEd, FACHE, and Maria Silveira, MD, MPH, Assistant Professor of the Bioethics Program at University of Michigan, Ann Arbor are co-authors of the study.

About the College of Nursing at the University of Colorado Anschutz Medical Campus: Founded in 1898, the CU College of Nursing offers bachelor’s, master’s and doctoral (DNP and PHD) programs to more than 900 students in two locations and online. Our master’s programs and online graduate programs are ranked nationally by U.S. News & World Report. New programs include a certificate in palliative care, and a DNP/MPH interdisciplinary dual degree and new master’s specialties in acute care and military and veterans’ health. Learn more about the college at www.nursing.ucdenver.edu.

Contact: Ryann Nickerson, Media Relations, University of Colorado Anschutz Medical Campus (C) 720.726.0378 ryann.nickerson@ucdenver.edu

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