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The Need for Advance Care Planning Conversations

All over the country, people in communities are starting to have “the conversation.” What conversation, you may be asking? Some know it as advance care planning. Author, lecturer and physician Atul Gawande, and many others in the field, are asking questions and researching what happens to people when the medical system, in its effort to save lives, provides care to seriously ill or dying people who don’t want it. Gawande, publishing in The New Yorker and in his book entitled “Being Mortal, Medicine and What Matters in the End”, tells the story of many patients he worked with, and his own father, who struggled with decisions about their care, what mattered most to them in living their lives, and how to have that “conversation” that makes their wishes known and followed by loved ones and medical teams.

Why Aren’t Conversations Happening More?

Being Mortal was featured in a documentary by PBS and aired on Frontline. The California Health Care Foundation reported that the program was widely viewed by over 2.4 million people, but viewership among African Americans, Latinos, and Asians comprised only 11% of viewing households. The viewing audience also lacked diversity in other areas such as education level and age.

So organizations such as the California Health Care Foundation and the Harman Foundation rallied, preparing a tool-kit for communities to use enabling them to easily sponsor events in neighborhoods where more people could be touched by, shown how, and start having these critical conversations. The end goal is to encourage people to identify and communicate their wishes to those who matter.

Are Conversation Efforts Working?

We know conversations are happening more. Examples are everywhere. The San Diego Coalition for Compassionate Care and many other organizations are combining forces to amplify advance care planning conversations: at a YMCA on August 9 in El Cajon, a city adjoining San Diego’s southeast border; among students during an annual week-long focus on what gives life meaning at Cal State San Marcos; and in over 50 other locations in California alone thanks to the California Health Care Foundation and the Harman Foundation’s toolkit. The same thing is happening all over the country. More and more people are learning and having “the conversation.”

Medicare Payment for Advance Care Planning Conversations is Helping…Some

Even though new reimbursement rules were issued in the past year by Medicare, which provide payment to providers for having these conversations with their patients, a Kaiser Family Foundation poll described by Cambia Health uncovered that conversations are still only happening 14% of the time between patients and their providers. Ironically, most patients, 80%, say they would like to have this type of conversation with their physician or health provider.

How the CSU Shiley Institute for Palliative Care is Helping

The CSU Shiley Institute for Palliative Care’s mission is to advance the availability of compassionate and appropriate care for those with serious or chronic illness. Through creation of a series of courses on Advance Care Planning, the Institute is helping more health professionals learn the fundamentals of this difficult topic, facilitate effective conversations, bill for the work they do, and expand their reach to serve more groups and communities. Offering courses is a measure of success, but there are still many more professionals to touch, so all forms of “conversations” can be held among those who need the greatest help.

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