At any phase of one's care, physicians need to ensure the treatment provided aligns with their patients' needs and expectations. Patients should also have a thorough understanding of the prognosis and an acceptance of the quality of life they'll be able to sustain after treatment. These are the ideals of the team behind the health program, Patient Voice.
Conversations around patient preferences, also called advanced care planning, are particularly important before their condition limits the patient's ability to express them. Some of these important medical determinations include whether or not the patient wants CPR if his or her heart stops, artificial respiration if his or her lungs can't function or tube feedings if he or she can't consume food without assistance.
Understanding the patient's goals for care can guide the provider in making treatment decisions that increase patient satisfaction, as well as honor one's wishes when he or she is most vulnerable.
Finding the patient voice
There are differing opinions about the best way to determine the patient's goals of care. When should it occur, and how can providers determine what the patient truly wants in end-of-life care and then follow those choices? A team of residents from the Department of Family Medicine at the David Geffen School of Medicine at UCLA are finding the answers through their Patient Voice program project.
The Patient Voice program uses qualitative data obtained through open-ended interviews with patients to understand their perspectives of a given topic. It is designed to eliminate barriers between the patient and provider, improve the delivery of care and optimize patient satisfaction as a result.
A team of eight medical residents chose to examine patient perception regarding advanced care planning, reflecting their role as family medicine physicians who provide care throughout a patient's lifespan. Because they develop a relationship with the patient, they are in a unique position to discuss his or her wishes and help target the interventions that fit with his or her values and beliefs.
However, many of the conversations about goals of care occur upon one's admission into the hospital, when he or she is experiencing emotional distress. "Nuanced discussions are very hard to have, so a many times they aren't being done in a way that represents what the patient's wishes would be. So, we saw a big opportunity to look into this issue on a deeper level," says Dr. Raymond Tsai, the de facto team leader.
The team will be conducting interviews with patients who have been admitted to the hospital at DGSOM. Tsai and his group will carefully record questions about how medical teams spoke to their patients with regard to advanced care planning, as well as the patients' perceptions, recommendations and reflections on that experience.
After each patient voices his or her opinions, the results will be synthesized and quantified. This data will then be presented to an interdisciplinary panel of stakeholders and patient care providers — including doctors of various specialties, professionals involved in medical ethics, members of the rapid response team, nurses, social workers and chaplains. This group will hear the Patient Voice data and develop possible solutions to improve a system that strives to conform to patient needs.
A work in progress
The team is currently conducting interviews and has already gathered some eye-opening information. "The exciting part about this project is that rather than coming up with an intervention based on our knowledge, intention or experience, we get to stop talking and really listen — which is why I think it is so meaningful to us," says Dr. Jen Macdonald, one of the residents working on the project.
The team anticipates having a project proposal for review by stakeholders and administrators soon.
By Kyleigh Roessner