London, Ontario CANSW Conference

Just 2 weeks to go before the Canadian Association of Nephrology Social Workers
Conference (October 21-23, 2009) in London, Ontario. The theme of the conference is: Beyond DNR: Re-thinking Advance Care Planning and Palliative Care.

Just Wondering

I confess I was eavesdropping--but the conversation was so near and so compelling, I couldn't help but listen. I was meeting with a colleague in her office, when one of her staff came to the door with a problem. Holding two patient files, one in each hand, the staff member, a home health intake nurse, said, "Okay, now we really have a problem." She went on to explain that both files had been received within the past half hour. Each file represented a patient currently in a local emergency department. Each patient required a specialized medication pump. "We only have one pump left," said the nurse, "and we have to decide who gets it. What do we do?"
Decisions such as this are made every day in healthcare. I wonder how often there's anything on the file that even resembles a directive or advance care plan indicating the patient's wishes. What does the patient want? How would healthcare providers distant from the patient (like my colleague and her staff member)have any idea about the patient's preferences, needs, and personal beliefs?
Just wondering.

Know and Do and Hope

My first conscious recollection of facing a life challenge that would be more than momentary, happened when I was 6 years old. As the oldest child in a family of five, I was the first one to go to school. Older neighbourhood kids had given me glimpses of what school was like, but I needed to experience it myself.

Thankfully, my parents were supportive and gave me answers to my 3 biggest questions:
What can I know about school?
What must I do at school?
What may I hope about school?

Throughout my life, as I’ve faced various challenges and walked into new situations, I’ve found myself asking and pondering situation-specific versions of these 3 same questions.

It is a useful exercise. It occurs to me that as healthcare professionals, we can use these questions to inform the conversations we have with our patients and their families. When faced with life limiting diagnoses, patients and families want to know:
What can I know?
What must I do?
What may I hope?

Not surprisingly, these same questions are good ones for me to ask myself when, as a healthcare professional, I seek to support others in their healthcare journeys.

Better Conversations

I think that the sports world has lots to teach those of us who work in the healthcare world. The athletes are always honing and perfecting their skills. Even, and maybe especially, the champions.
Detroit and Pittsburgh will shortly be playing for the Stanley Cup. The players on these teams fit all the criteria for excellence in hockey, but I'm confident that not one player feels that his past wins/successes will be enough to get him on the ice each night of the playoffs. I know that "practice" is just a given for these elite athletes.
The other day I was in a meeting on the topic of good communication between clinicians and patients/family members. A couple of meeting participants maintained that their clinicians "always did a wonderful job of communicating with patients and families."
Hmmm....these clinicians may be wonderful communicators, but if they really are, I would think they must practice and they must always be looking for how to improve their skills.
The truth is, good communication can be learned, and great communicators are always looking for ways to do it better. The "Stanley Cup for Healthcare Communications?" Far-fetched, for sure, but if such a contest were to exist, there's not one of us who wouldn't want to say, "My healthcare clinician is on the winning team."

Patients Identify ACP Barriers

Tracking the Care of Patients with Severe Chronic Illness

I guess it shouldn't surprise me, but when I looked at the information in the April, 2008 Dartmouth Atlas of Health Care, I was taken aback. The Atlas looked at the outcomes of chronic disease care and tracked these outcomes against the resources attached to them. It was found that when it comes to getting care for a chronic disease, geography matters. Depending on where they live and what hospital or health care organization they use, these patients receive very different care.
These variations in care appear not to be linked to how sick the patients are, and, it turns out that the places where more resources are available are not the places demonstrating better care and better health outcomes.
This article focuses on supply sensitive care for patients with severe chronic illness in the last 2 years of their life. Areas that had offered more resources actually had a slightly higher mortality rate (over a period of up to 5 years) for patients following acute myocardial infarction, hip fracture, and colorectal cancer diagnosis--with no difference in functional status. As well, in higher-resourced settings, patients reported worse access to care and greater waiting times, with no difference in patient-reported satisfaction with care.
Paul Batalden's quote is so appropriate: "Every system is perfectly designed to get the results it gets."

What Would Happen if We Actually Listened to Each Other?

What Matters Most in End-of-Life Care: Perceptions of Seriously Ill Patients and Their Family Members.