Shirley Otis-Green on the Importance of Integrating ACP into Your Medical Practice

The patient-centered approach at the heart of palliative care is dependent on a simple concept: knowing a patient’s values and wishes at any stage in life – even before a health crisis.

That’s the focus of advance care planning, a skill clinicians use to draw out essential whole-person information and translate it into goals of care.

It might sound easy, but it requires intention, training and practice, said Shirley Otis-Green, MSW, Clinical Director of Consulting Services for the Coalition for Compassionate Care of California, an advocacy group for quality end-of-life care.

“A lot of us do assume that we know what we need to know, and we can do it just fine, thank you very much. —Shirley Otis-Green, MSW

• Video Transcript

  I’m Shirley Otis Green, and I’m delighted to be here. I’m from the Coalition of Compassionate Care California and we’re an advocacy organization for the seriously ill and I have a chance to talk to people here in regard to the Advance Care Planning Program that you have classes on, and that the concept is so incredibly important.

  We want palliative care providers, but all healthcare professionals to be able to provide person centered care. And that requires a conversation with a patient in regard to what they value most.

  What their concerns are?

  What their fears are?

  What are the things that give meaning to their life?

  And being able to engage learners in better understanding in perfecting the skills to be able to have those kinds of meaningful conversations, that’s really important. A lot of us do assume that we know what we need to know, and we can do it just fine, thank you very much. But we know that from lots of evidence out there that patients tell us that those conversations are not always as in-depth and as useful as they would actually like them to be. And we know from the realities of care that’s delivered, there’s often a mismatch. So, our current way of doing this has been less than optimal.

  People too often get default care, which results in care that they don’t necessarily need or want, or benefit from. And it costs then our society a great deal of money. And it costs the patients potentially regret and time lost from the quality things that matter most to them. Family members then, are left with potentially, complicated bereavement. And a legacy of remembering their mother in an ICU bed, instead of being able to be at home looking out into the window of her backyard seeing the garden that she loved, and with her kitty curled up on her lap, and her granddaughter playing at her bedside.

  So, being able to create memories for the survivors, and being able to have the best and absolutely the most personalized and tailored care delivered to patients is, unfortunately, not being delivered consistently and reliably across settings. So, that leads us to believe that there is additional information that people would benefit from.

  The Advanced Care Planning curriculum at CSU is really wonderful. It gives people an opportunity to take the experience that they have, the good bedside skills that they already have, the clinical expertise that they have, but spend some time really thinking about, and explicitly exploring strategies for best practice related to end of life conversations. And hopefully, bringing those conversations earlier for people, so that all the patients that one sees can have the care that’s really tailored for them in the very best possible way.

The Art of Asking, Listening

It all starts with a conversation.

“(Advance care planning) is so incredibly important,” Otis-Green said. It’s about learning “what patients value most, what their concerns are, what their fears are, and what gives meaning to their lives.”

She said many clinicians underestimate the skill required for such conversations.

“A lot of us assume that we ‘know what we need to know, and it’s all fine, so thank you very much’,” Otis-Green said. “But we know from lots of evidence … that those conversations are not always as in-depth and useful as (patients) would like them to be.”

Using What You’ve Learned

Worse, she said, there’s often a “mismatch” between what patients want and the care that’s ultimately delivered.

“People often get default care that they don’t need, want or benefit from, which costs our society lots of money,” Otis-Green said. “And it costs patients time lost from the things that matter most to them.”

What’s the solution?

Great training, such as the Advance Care Planning courses offered through the CSU Shiley Institute for Palliative Care, she said.

Building Skills Takes Training

“The Advance Care Planning curriculum at CSU is really wonderful,” said Otis-Green. “It gives (providers) the opportunity to take the experience they have – the good bedside skills and clinical expertise – and spend some time thinking about and explicitly exploring strategies for best practices related to end-of-life conversations.”

The Coalition for Compassionate Care of California helped create the content for the Advance Care Planning curriculum in partnership with the Institute.

Institute Courses Equip Clinicians for ACP

As part of that effort, a new course – Integrating Advance Care Planning into Your Medical Practice – has recently come online.

Otis-Green said the Institute’s Advance Care Planning courses explain how to “start those conversations earlier, so that all patients can have the care that’s tailored for them in the best possible way.”

“The people that have put together the curriculums here at CSU have done a tremendous job to look at evidence-informed approach and skill development,” Otis-Green said. “Being able to engage learners in perfecting the skills (needed) to have those kinds of meaningful conversations is so important.”

For more information on the Institute’s Advance Care Planning curriculum, click here or call 760-750-4006.