Too often in our health care system, patients do not receive the care they wish for as they approach their last days. Starting a conversation about end-of-life care is difficult for all of us, whether we are physicians, patients, family members, religious and community leaders, or health care providers. It is, however, imperative that these conversations happen. And once they occur, it is equally critical that patients’ choices are honored by those who care for them.

The Wisconsin Medical Society is considering a major initiative to improve this situation though system change, community outreach, and education around advance care planning. Modeled after Honoring Choices Minnesota, the Society would serve as a convener, coordinator, and catalyst for clinical pilot projects, combined with aggressive outreach in communities across the state.

Coordinate Pilot Projects: The Society proposes to coordinate pilot projects to facilitate advance care planning discussions and improve access to palliative care in Wisconsin hospitals, clinics, and other health care settings. The concepts, methodologies, training systems and materials will be based on Respecting Choices, a pioneering organization in advance care planning based in La Crosse.

Collaborate in the Health Care System: By agreeing to collaborate around a shared model, hospitals, physicians, and communities can enjoy greater benefits and avoid duplicating work to improve advance care planning. As convener, the Society will provide a platform for pilots and stakeholders to share lessons and information. The Society will share program materials, templates for action, and institutional knowledge in person, through an annual conference, and on its website.

Reach into the Community: As pilot sites are implemented and expand, the Society will lead the public drive to promote advance care conversations among patients and their families, friends, and communities. This effort will be a combination of community outreach, physician engagement, and interaction with religious institutions and multicultural groups. The Society hopes to build significant media projects with Wisconsin television, newspaper, and radio as well.

Establish a Uniform Advance Directive (AD): Although legally acceptable ADs can take many forms, standardization will improve patient care and participant engagement. A standardized AD should be understandable across literacy levels.

Measure Success: The project will set short-range percentage targets for populations in Wisconsin with a complete Advance Directive. Long-range targets will measure hospice days and ICU days in the last six months of life, the number of ADs a patient has completed by the end of life (a way to “track the conversation”), and satisfaction and depression rates among family members six months after death of a loved one.

For more information about this important project, please contact Society Policy Analyst John Maycroft at john.maycroft@wismed.org.

Links

• Honoring Choices Minnesota
  A partnership of Twin Cities Medical Society and Twin Cities Public Television
• MetroDoctors.com
  Contains information about pilot sites, facilitation trainings and outreach efforts in the Twin Cities


• Respecting Choices
  A department of the Gundersen Lutheran Medical Foundation
• Consider the Conversation: A Documentary on a Taboo Subject
  Co-produced by Wisconsin natives Mike Bernhagen and Terry Kaldusdahl, Consider the Conversation is “an intimate story about the American struggle with communication and preparation at the end of life.”