Segment 7 - Successful Discussions on Advance Care Planning and EOL

How can discussions on advance care planning and end-of-life care be successfully broached with patients and their family members?

"The issue of advanced care planning, end of life, and hospice which were earlier raised I think are also a challenge for many oncologists," said Joseph Alvarnas, MD. He cited a study published in JAMA that revealed that there is discordant understanding on the prognosis between the physician and the patient. The patients seemed to be more optimistic about their survival prognosis, while the oncologists may not. Alvarnas wanted to know how this could be rectified.

Rebekkah Schear, MIA, narrated the story of a friend who lost her father to cancer and then her mother was re-diagnosed. The family could not agree on the treatment plan, especially when deciding on the mother’s transition from active treatment to hospice. "I think that's it a very emotional, challenging subject and the experience of family members and the dynamics of families plays into that in a significant way." She added that a nurse navigator or a social worker can play an extremely important role in guiding the family through the process.

Going back to her friend's story, Schear said, "I got on the phone with a 3-season nurse navigator who had been working in oncology for over 25 years, and with her sisters we sort of helped them the set of questions that they should be asking the rest of the family and also questions to pose to their mom about what she wanted as her cancer journey came to a place where it was and as her prognosis worsened."

Michael Kolodziej, MD, said that as he looks at this now as an outsider who’s been there, he realizes how certain aspects of care are managed very poorly or not handled at the right time. “We do it when we’re facing a crisis typically. That’s not when you get the most responsive, receptive, constructive dialogue necessarily going.” The entire treatment plan should be addressed right up front, and the opinions of the family members should also be given consideration.

When asked if CMS coverage for discussions on advance care planning for Medicare patients would push this process, Kolodziej said he didn't think so.

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