Journal of Gastroenterology and Digestive Diseases

Integrating advance care planning education early in cirrhosis care: An interdisciplinary model to increase uptake

World Liver Conference 2018
May 25-26, 2018 | New York, USA

Amanda J Brisebois

Grey Nuns Hospital, Canada

Keynote : J Gastroenterol Dig Dis

Abstract:

Advance 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 and a Gastroenterology specialist or General 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 this time. The use of a formalized process, visual aids, 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 wellinformed surrogates. We have shown significant value of interdisciplinary outpatient clinics to educate health practitioners and patients, and wish to promote this globally. e: amandab@ualberta.ca

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