Cancer clinic finds advance care planning education “well received” by staff, patients

With support from a CareOregon's CSSI program, Northwest Cancer Specialists is taking a systematic, measured look at how they share with their patients information about advance care planning.

Northwest Cancer Specialists’ seven clinics include 42 oncology providers.

“We realized we really need to do a better job of advance care planning,” says Angela Kalisiak, MD, a medical oncologist.

As anyone who has followed the white-hot health care debate this year can attest, advance care planning is not an easy subject.

And it’s not easy even when politics hasn’t roiled the waters. Doctors worry about how long it might take, and are sensitive to broaching the subject with patients.

Many doctors worry that just having the conversation might make patients think the doctors are not going to work as hard for their care, Dr. Kalisiak says.

A different approach to patient information

Northwest Cancer Specialists advance care planning team included Dr. Angela Kalisiak and nurse Robert Steele. The pilot offices now prominently display advance care posters featuring the clinics' own medical staff. Photo by Jerry Rhodes

With CSSI support, Northwest Cancer Specialists’ Rose Quarter Cancer Center and St. Vincent Office have been testing ways to improve patient information about advance care planning.

“We started with something that we had no idea how brilliant an idea it was at the time,” Dr. Kalisiak says.

To help physicians and staff overcome their reluctance to say the wrong thing, they tried staff education first.

“It was hugely well received,” she says.

St. Vincent Practice Manager Charmaine Houriet is a member of the CSSI team. She also was among the staff members who learned about advance planning for themselves.

“Most of us didn’t have an advance directive,” she says. “We hadn’t sat down and pondered with our families about what we wanted.”

It was helpful and very important to grasp the idea that advance planning is not just “end-of-life care,” but rather is the responsible thing to do for any adult, just like preparing a will, Dr. Kalisiak says.

“Truly it’s something for every age,” Charmaine says.

And the experiment brought unexpected benefits for the clinic teams.

“It opened the door to supporting each other,” Dr. Kalisiak says. “It’s hard work to go from a difficult conversation with one patient and then be ready to take care of the next person’s need. Talking about these things and finding better ways to take care of the patient really supports the staff too.”

Patient reaction: welcoming

To test how patients would react, the clinics used the week of April 16, National Health Care Decisions Day, as an opportunity to make the program visible to patients.

All week, the clinics held workshops on Advance Directives and Physician Orders on Life-Sustaining Treatment (POLST). They handed out information to patients. They checked how long it took to give information and ask whether patients had advance planning documents already. They gauged whether patients and their families reacted negatively to the subject.

The results were more than promising.

• The time factor wasn’t really an issue.
• Negative reactions were nil.
• And about one third of patients had advance directives, a surprise to the clinic, which only had records of 5 percent.

Working from the results of those tests, the clinics have made some changes already. Displays in the clinics now feature advance planning information prominently.

One promotional idea that will definitely be exported to Northwest Cancer Specialists’ other five clinics is to create posters promoting advance planning and featuring the clinic’s own physicians being active and with their families.

And the effort won’t just be on National Health Care Decisions Day.

“We’re now working on advance care planning education that’s not just once a year,” Dr. Kalisiak says. “We’re working on better ways to identify those patients who need them. We're working on how to get them, how to get them in the charts and how to work with referring doctors.”

“Because we have made it a normal part of the practice,” says Robert Steele, RN, a gynecological oncology triage nurse at the St. Vincent office, “it’s something we talk about regularly and more freely with patients.”