Our Palliative Care and Shared Decision Making Recommendations are ready for prime time. Both were adopted by our members at the November meeting – now we move into the harder phase, implementation. First, I’d like to introduce these two recommendations and let you all get to know one another a little better.

Palliative Care

Palliative care was selected as a priority topic for us because while palliative care shows again and again improvement in outcomes for patients across settings, the majority of people who would benefit are not receiving the service. There are many reasons why this is including lack of workforce, lack of referrals, lack of a sustainable business model, and lack of an understanding about palliative care.

We know that people with serious or advanced illness often experience increases in symptoms coupled with a decrease in function. Traditional life-prolonging or curative care often does not meet a person’s range of needs as illness progresses. Palliative care, as defined by the National Consensus Project, “focuses on expert assessment and management of [symptoms including] pain…assessment and support of caregiver needs, and coordination of care [attending] to the physical, functional, psychological, practical, and spiritual consequences of a serious illness. It is a person- and family-centered approach to care, providing people living with serious illness relief from the symptoms and stress of an illness.” We argue that palliative care can be offered alongside curative treatment at any age or stage of illness and can address many unmet patient needs.

To help address the issues with access, we developed four focus areas:

  • – Defining palliative care using the standard definition developed by the National Consensus Project including appropriateness of primary and specialty palliative care.
  • – Spreading awareness of palliative care.
  • – Clinical best practice provision of palliative that is:
    • * Responsive to local cultural needs,
    • * Includes advance care planning as outlined in the 2014 Bree Collaborative End-of-Life Care Report and Recommendations including appropriateness of an advance directive and Physician Orders for Life-Sustaining Treatment (POLST) or similar suitable document, and
    • * Incorporates goals of care conversations into the medical record and plan of care.
  • – Availability of palliative care through revision of benefit structure such as a per participant per month (PPPM) benefit.

Learn more here.

 

Shared Decision Making

Shared decision making is another topic that is not used enough. Our goals here are to create a common definition, and we use the Washington State Health Care Authority’s framing of shared decision making as “a process that allows patients and their providers to make health care decisions together, taking into account the best scientific evidence available, as well as the patient’s values and preferences,” and to help move our delivery system toward adoption.

We argue that shared decision making is a key component of patient-centered care, appropriate for treatments, management options, or screenings that are: (1) preference-sensitive and (2a) have high-quality clinical evidence for more than one option including no treatment or (2b) that have a lack of evidence and no clinical consensus on the best option (i.e., clinical equipoise). To be effective, shared decision making must be supported by high-quality communication between a provider and patient, and in some cases family members or others, about risks, benefits, and exploration of values and goals.

Our goal is statewide movement toward greater use of shared decision making in clinical practice at a care delivery site and organizational level using a stages of change framework (i.e., precontemplation, contemplation, preparation, action, maintance). We frame our recommendations under four priority focus areas:

  • – A common understanding and shared definition of shared decision making and the benefit of shared decision making.
  • – Ten priority areas as an initial focus for the health care community.
  • – Highly reliable implementation using an existing framework customized to an individual organization.
  • – Documentation, coding, and reimbursement structure to support broad use.

Learn more here.

Ginny Weir, MPH
Director, Bree Collaborative