Tell Me More - A Stepwise Approach to Meaningful Conversations Resulting in Goal Concordant Care

Residents in long-term care settings have multiple chronic illnesses that contribute to an overall poor prognosis. Studies have shown that the median survival of a nursing home resident is 2.2 years. Despite this poor prognosis, the incidence of advance care planning and goals of care conversations remains low, leading to inappropriate and unwanted treatments and difficult last-minute decision-making for family members. Not only are advance care planning conversations difficult and time-consuming, but some clinicians have not had the necessary training. As a result, proactive and timely advance care planning and goals of care conversations are replaced by last-minute/crisis conversations, which lead to unnecessary, harmful, and unwanted treatments. Sometimes a healthcare provider is so focused on treating the acute changes in condition that he/she fails to see the big picture in terms of advanced or terminal illness and the resultant poor prognosis.

This interactive session will describe a distinct six-step advanced illness model which will serve as a guide for clinicians to have a meaningful goals of care conversation. The session will also help clinicians identify and prognosticate advanced serious illness. Facilitators will provide the talking points needed to navigate the complexity and nuances of these meaningful conversations. Potential barriers to an effective conversation will be discussed. Case studies utilizing role play will demonstrate the hands-on approach for the advanced illness conversations.