Program on health care decisions starts

By Deidre Jacobson

Providence Health Care has begun a pilot program in Spokane to help patients and their families reflect on and share about their future desires related to health care and end-of-life decisions.

Kellie Durgan guides discussions

Patients express who they want to speak for them if they sustain an injury or have a disease that compromises their ability to speak for themselves, what their end-of-life-care wishes are, and they share this information with their loved ones so they can honor those wishes even if they differ from their own.

These questions and decisions around them are the work of advanced care planning manager Kellie Durgan, with Providence Health Care’s Advanced Care Planning program.

She uses Gunderson Health’s “Respecting Choices” curriculum with a team approach. Health care providers invite patients to begin the conversation and then work with a trained facilitator—typically a medical assistant, registered nurse or social worker in outpatient settings—to choose a health care agent and complete a living will or Physician’s Orders for Life Sustaining Treatment (POLST) form.  

Respecting Choices began with a Providence Foundation grant in April 2015 at Providence St. Joseph’s Care Center, Providence Internal Medicine and Providence Family Medicine North. 

At these sites, trained facilitators, who are not physicians, begin with questions about end-of-life planning, engaging patients and families in looking ahead. 

“Many people assume families know what loved ones want, but they often don’t.  At other times, people designate a health care agent and never tell family they selected someone,” said Kellie.

“It is difficult for families to make decisions without knowing their loved one’s wishes.  Families who are aware of the wishes suffer less and have less anxiety when they have to make painfully difficult decisions.  Moving this conversation upstream, before the crisis, is important,” said Kellie. 

A focus of this advance care planning is facilitating a conversation between someone and the person chosen to be the health care agent—known as a durable power of attorney for health care. 

This conversation allows the health care agent to hear directly from the person what they would and would not want with respect to health care. 

Kellie said it is important that the discussion happens before the patient is unable to decide. 

If a person has a non-recoverable accident, the family may wish to stop aggressive treatment.  When there is no durable power of attorney for healthcare, the first in line legally to make these complicated decisions is the spouse, then the adult children, she said. 

In Washington, if there is not a chosen health care agent, all the children must agree before the treatment course can be changed.  The tendency in medical settings is aggressive treatment.

Respecting Choices offers information to help people prepare to make health care decisions, including end-of-life decisions for loved ones in the event they are unable to make their own. 

They may be asked to choose medical care, such as tests, medicine and surgery.  They may be asked to discontinue treatment based on the person’s instructions or what is in their best interest.  They may also need to decide what organization or health care professional should provide care. 

Statements such as “I just want to die with dignity,” “don’t keep me alive if I’m a vegetable” or “just make me comfortable,” can have different meanings for different people, Kellie said. 

The emphasis is on “The Conversation” between patients and their agents or surrogate decision-makers, she said. As health care agents understand why patients would choose aggressive treatment, comfort care or somewhere in between, they are better able to be a patient’s own voice when directing care at end of life. 

For more than 19 years, Kellie as a nurse at Holy Family Hospital said her “most meaningful role was as a patient advocate and empowering patients to make informed choices about the care they receive, especially when they cannot speak for themselves.”

Kellie attends St. Thomas More Catholic Church and has served six years on the Catholic Cemetery Board. Her service on the Providence Ethics Committee engaged her in conversations around end-of-life work. 

“How can we do a better job of encouraging, helping and inviting patients and families to engage in the process?” said Kellie.  “They need good information and time to work through decisions with people who will walk beside them as they make them.  Families who do this work in advance seem more peaceful about these decisions.”

Providence Visiting Nurses Association and Adult Day Health and most Providence primary care clinic locations have been added to the initial three sites. 

Providence sees this work as an expansion of their mission to care for the poor and vulnerable. They are working to grow the service within their ministries, said Kellie.  Training has begun for nurses and social workers to assist with the more clinical POLST conversation.

Providence Health Care is involved with a state-wide organization, Honoring Choices Pacific Northwest, which works in state health care organizations using the Respecting Choices model to provide a common language around advance care planning. 

“One man had DNR tattooed on his chest over his heart. That shows you how important these decisions are to some people” said Kellie.  “The force for Respecting Choices is empowering patients to make choices about care they receive through all of life’s stages.”

Copyright © November 2016 - The Fig Tree