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Journal of Gastroenterology and Digestive Diseases | Volume 3

May 25-26, 2018 | New York, USA

World Liver Conference 2018

dvance Care planning (ACP) and goals of care designation

(GCD) are being increasingly discussed amongst specialists

and generalists involved in the care of patients with cirrhosis.

Uptake and adoption of integrating these discussions into

standard inpatient and outpatient care have been limited

with physicians citing many perceived barriers and limitations.

Based upon the literature evidence-base and our experiences,

we provide an actionable framework that can be readily

implemented into a busy clinic setting, or in in-patient

populations, suitable for use by any practitioner. A set of two

educational pamphlets, including an ACP cogwheel and figures

explaining the course of chronic illness have been implemented.

Discussions have involved both Palliative Care (and Internal

Medicine) specialist andaGastroenterologyspecialistorGeneral

Medicine specialist, as well as an inter-disciplinary team, the

patient and their surrogates. The percentage of patients with

ACP and GCD documentation has increased dramatically during

thistime.Theuseofaformalizedprocess,visualaids,educational

pamphlets, has been integrated into care in both the outpatient

and inpatient settings. These tools can be customizable based

on the underlying gastroenterological (GI) disease, and are

hoped to be conversation starters in many clinical settings.

In our practice, this assemblage of “best practice tools” has

increased the number of outpatients with cirrhosis, and other

GI chronic illnesses, who have actively contributed to their

GCD prior to acute health events and are supported by well-

informed surrogates. We have shown significant value of inter-

disciplinary outpatient clinics to educate health practitioners

and patients, and wish to promote this globally.

Amanda J Brisebois

Grey Nuns Hospital, Canada

Integrating advance care planning education early in cirrhosis care: An inter-

disciplinary model to increase uptake