How Is Information and Education Provided to Almost 30,000 Staff?
As previously mentioned, FHA has 26,000 staff and 2,500 physicians. Educating and providing information to them has been one of our most significant challenges and one that has been extremely difficult to resolve. One method of communication, the development of online learning modules, has assisted with the challenge of educating large numbers of staff. We also place news items in e-newsletters and have an internal website where we host information.
ACP education sessions prepare students to become mentors and leaders in their programs and settings. This by far has been the most successful communication strategy. Following education, students are supported by the Project Implementation Coordinator, particularly when individual patient and family situations, as well as implementation issues, arise.
As part of the MOST initiative, Program and Implementation Leads have been identified in all 15 adult program areas and are supported by the ACP Project Implementation Coordinator as well as Clinical Nurse Specialist from the End of Life Program.
Who Has the Time?
We have heard many times through the years that clinicians do not have time to engage in ACP conversations. As part of our ACP education, role playing is an integral part. This is certainly due in part to practice engaging in ACP conversations, and to illustrating how much ACP can be accomplished in a focused 20-minute discussion. Noting and highlighting this during the education sessions has been eye opening for people. We do, in fact, have the time.
In addition, ACP is a shared responsibility. For example: social workers' or nurses' roles are to learn about and understand the adult and what is important to them (Core Element 2); physicians or nurse practitioners' roles are to speak to patients and families about their diagnosis, prognosis, and treatment options (Core Element 3). All clinicians are involved in ensuring interdisciplinary involvement (Core Element 4) and defining goals of care, documenting, and creating a care plan (Core Element 5). The ACP Record Form has been instrumental in illustrating this concept and clinicians feel confident in filling out “Next Steps” for colleagues to follow up and continue the conversation.
How Do You Reach the Physician Group and Move From a Curative Medical Model of Care?
The medical model prevails in health care. We continue to be challenged with changing the culture of “treatments and cure,” to openly discussing the risks and benefits of treatment options with individuals, and grounding decisions in quality of life and personal goals and wishes. From our experience, individuals will often choose pain and symptom treatments that provide improved quality of life. Certainly the goal of ACP is not to promote less medical interventions, but to promote decisions based on fully informed and accurate medical information.
The education of and information sharing with physicians has also been a challenge. We have developed physician-specific education modules for ACP that includes pre-work, a 4-hour classroom session, completion of a 20-minute online module, and a follow-up 3-hour classroom session. Classroom session objectives include:
1. What is ACP and how we can be more effective as physicians in initiating these conversations and in overcoming barriers?
2. What are the legal issues and applicable provincial legislations related to ADs and the role of substitute decision makers?
3. What are the skills needed for effective ACP conversations and to practice them?
How do we recognize and resolve potential conflict situations?
4. Review of the Medical Orders for Scope of Treatment (MOST) form and policy.
Our personal experiences with illness, disease, death, and dying within our families and communities shape how we engage in ACP with the people we support and care for in health care, regardless of our culture or our discipline.
Building a successful ACP program in any organization requires passion, persistence, and pennies. The ACP journey requires patience and paced change initiatives. Change needs to be coupled with a sense of knowing (a) the system readiness, (b) clinician readiness, and (c) community readiness. The path is not linear, but the path is an adventure!
Canadian Hospice Palliative Care Association. (January, 2012). Advance care planning in Canada: National framework. Retrieved from advancecareplan- ning.ca/media/40158/acp%20framework%202012%20eng.pdf
Ipsos-Reid Poll. (March, 2011). Retrieved from advancecareplanning. ca/news-room/national-ipsos-reid-poll-indicates-majority-of-canadians- haven't-talked-about-their-wishes-for-care.aspx