You only get one chance to make a first impression. This is especially true when approaching family members to discuss end-of-life alternatives.
“There are certain moments in our life that are indelible … that we’ll never forget,” said Anna-Gene O’Neal, president and CEO of Alive Hospice. “Critical communications, particularly around mortality, are conversations that stay vivid, that stay real, and that stay with us. We don’t really get a chance for a ‘do over’ if we don’t do it well.”
To help ease those conversations and make them less stressful and more productive for everyone involved, Alive Hospice is creating a simulation lab for advance care planning discussions. Made possible through a $150,000 grant from the Memorial Foundation, the lab is anticipated to open on or before this September.
“The Memorial Foundation is just an incredible organization and truly a gift to our community,” O’Neal said of the support that has been provided to nonprofits across Middle Tennessee for more than two decades. She added this latest gift would help Alive Hospice answer a critical unmet need in the community.
“In an IOM report, more than 85 percent of those surveyed say they want to die at home surrounded by friends and family,” O’Neal said. Despite this desire, many individuals eventually die in the hospital. “We need an opportunity to do things differently,” she continued.
O’Neal added hospice services often are not activated until very near the end of someone’s life. Yet, research continues to show those in hospice care frequently live longer and with greater quality of life. “We’ve had so many patients who are late referrals to hospice,” O’Neal said. “But once we get them, we have so many clients who say, ‘If we had only known earlier the impact this could have made on our family.’”
Instead of just wishing people would consider hospice earlier, O’Neal said the team at Alive Hospice really began thinking about the barriers to earlier entry and ways to overcome those obstacles. One major issue is a dread of broaching the subject with families and a fear of mishandling such a sensitive topic.
The goal of the new simulation lab is to provide a safe place to hone skills and develop a personal style to discuss end-of-life options, allowing providers to make missteps and corrections before facing patients and families who are already in a fragile state.
“If we create this environment to teach and to train in a way to be able to help healthcare providers, then that is going to set us all up for success with our patients and our families at the moment those conversations should occur,” she said.
“We want to take them through very emotionally challenging discussions … and frankly medically and ethically challenging discussions … to be able to immerse them into all types of end-of-life conversations,” O’Neal added. “We’re using intentional adult learning theory as the model to make sure we have success.”
She continued, “We’ll have trained actors who portray individuals at different emotional states in the understanding of their disease to be able to create as lifelike, real world discussions as possible,” O’Neal said. “This is way beyond the classroom didactic. The intent of this is really immersing individuals into their verbal language and their non-verbal language.”
The simulation lab is located at Alive Hospice’s Training Center on 18th Avenue North in close proximity to a number of hospitals, universities, medical practices and clinics, and faith communities. The space is being set up to look like a patient’s room with a hospital bed and equipment emulating the sights and sounds encountered in an acute care setting.
O’Neal added the conversation simulations would be videotaped to allow for debriefing and to reset areas that might need more work. She noted the stages of grief don’t follow any direct order or timeframe so providers have to be prepared for various emotions and responses. “Grief doesn’t happen in a neat line,” she said. “Grief is a scribbly mess.”
With practice and preparation, however, providers can get past feeling intimidated and uncomfortable. “Our goal when they leave is that they feel confident and secure and know they also have a resource if they have questions down the line,” O’Neal said, adding she anticipated a two-hour time commitment should give participants really good exposure to numerous scenarios.
One of first people planning to take advantage of the new resource is Dan Hogan, president and CEO of Medalogix, a Nashville-based, post acute predictive analytics and population health management firm. If all goes as he expects, Hogan said, “I will not only put my entire staff through the training, but I’m going to make it part of our onboarding process so when we hire new employees, they’ll go through it, too.”
Although the Medalogix staff will never have end-of-life conversations with a family, the company’s Bridge tool uses analytics to identify the right patients to link to hospice care at the right time. “It’s a victory when we identify patients early on who will benefit from hospice care,” Hogan said. However, he continued, “It’s important to me and for everyone on the Medalogix staff to remember that whenever our software works well, there is a conversation at the end of it that someone will never forget.”
He added that because his team is so data driven, “It’s very easy for us to get lost in the 1s and 0s.” Hogan continued, “I’m constantly looking for ways to drive home the patient impact.”
O’Neal said the hope is that the lab will benefit a broad spectrum of healthcare industry professionals and ultimately be accessible to the community at large
“We feel it’s critical for us, with what we do, to make the best of something that’s really tough and hard – and we’re committed to that upstream,” she concluded.
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