Your Voice/Your Values
Sandra Lauer, RN Kathleen T Grimm, MD
June 22, 2017
The Conversation Project at
Erie County Medical Center
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#VITAL2017
Erie County Medical Center (ECMC):
• Located in Buffalo, NY
• Safety net hospital
• Most of the population surrounding this hospital are Medicaid
recipients/economically depressed area
• Racially segregated
• Disparity in end-of-life care
• Level 1 Trauma Center
DECONSTRUCTING THE ADVANCE DIRECTIVE
Values-Based Conversations
Advance Care Planning
What makes an effective approach?
• Shift the focus of end-of-life decision making away
from document completion and toward facilitating
discussion of values and preferences.
• Do not stress importance of making choices about
every possible intervention
• Provide guidelines for how to make decisions
-Institute of Medicine Dying in America Study, 2014
The Conversation Project
“We talked about everything except one thing:
how she wanted to live at the end of her life".
-Ellen Goodman
http://theconversationproject.org
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The Conversation is NOT about Legal
Documents
It is about OUR wishes and
values
It is about family, friends, and
loved ones and their
understanding and commitment
to carry out your end-of-life
wishes
It may result in important
documents
Conversations with Patients
Remember that the goal is to
stimulate authentic dialogue!
http://abcnews.go.com/Health/video/conversation-dr-atul-gawande-17330322
Early conversations about goals of care
benefit patients and families
- Enhanced goal-concordant care
- Time to make informed decisions and fulfill personal
goals
- Improved quality of life
- Higher patient satisfaction
- Fewer hospitalizations
- Better patient and family coping
- Eased burden of decision-making for families
- Improved bereavement outcomes
Mack JCO 2010; Wright JAMA 2008; Chiarchiaro AATS 2015; Detering BMJ 2010; Zhang Annals 2009
ECMC INITIATIVES
o Build a coalition that includes Palliative peer
advocates/Community health workers
o Activities that are paired with existing activities
(health fairs/community group presentations)
o Partnerships that include pastors/attorneys
o Leadership buy-in
o Exemplify the importance ACP within our
organization
Normalizing The Conversations
• It’s not just the elderly or the sick, it’s for
young and healthy individuals as well!
• It’s planning for your future just like you
do financial planning, you should plan for
how you want to live the remainder of your
life
• It’s a part of wellness
Your Voice, Your Values
Take Your Proxy to Dinner Campaign
I have a healthcare directive not because I have a
serious illness, but because I have a family.
- Dr. Ira Byock
Your Voice, Your Values
The Conversation Project at ECMC