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Patient-Centered Care E-Newsletter September 2016

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   September 2016     Issue No. 13
Patient-Centered Care News
The other day I read this description of Patient-Centered Care which I wish to share as I think it sums it up well: "In patient-centered care, the patient is the source of control for their care. The care is customized, encourages patient participation and empowerment, and reflects the patient's needs, values and choices. Transparency between providers and patients, as well as between providers, is required. Families and friends are considered an essential part of the care team."
We hope that you find this complimentary monthly e-newsletter informative. Below are short summaries of each selected item with links to the entire pieces. Also included is a downloadable PDF version for readers who prefer that format.
Please feel free to send any questions or comments to comm@healthcarechaplaincy.org.
Rev. Eric J. Hall
President & CEO
HealthCare Chaplaincy Network & Spiritual Care Association
Thought for Today ----   An Imperative for the Chaplaincy Profession
One of the best practices that chaplaincy has long resisted is establishing standard practice. Chaplains are used to operating on intuition or "just being." Part of the resistance is that many chaplains have a misunderstanding of what standard practice is and is not. What it is not is giving up the art of chaplaincy or using the training that teaches us to respond to the other as an individual. Standard practice means that everyone knows how something is done and does not have to guess. It also means that everyone outside the chaplaincy department knows what to expect when they interact with a chaplain. Standardized practice can also mean that the chance of a process going wrong will be reduced or eliminated. It is time to move forward.
Spirituality and Health Care

Spiritual Advice for Surviving Cancer and Other Disasters (Washington Post)
An oncologist briskly walks into the consultation room, greets me and my wife, double-checks his chart and pulls up a computer image.

"It's cancer," he says.

As the shock starts to wear off, I cry. My oncologist tries to engage me in small talk. "What is it you do for a living?" he asks. I inform him that I'm a college professor and that I do disaster research.

After a slight pause, he replies, "Looks like you're in for your own personal disaster."
Experiences and Expressions of Spirituality at the End of Life in the Intensive Care Unit (ATS Journals)
Background: The austere setting of the intensive care unit (ICU) can suppress expressions of spirituality. Objective: To describe how family members and clinicians experience and express spirituality during the dying process. Setting: 21 bed medical-surgical ICU Methods: Reflecting the care of 70 dying patients, we conducted 208 semi-structured qualitative interviews with 76 family members and 150 clinicians participating in the 3 Wishes Project. Interviews were recorded and transcribed verbatim. Data were analyzed by 3 investigators using qualitative interpretive description.
Patient Experience
A Nurse Writes ----     4 Ways Nurses Can Indirectly Influence Patient Experience (HealthLeaders Media) 
  1. Acknowledge Patients' Suffering
  2. Create 'Radical Convenience'
  3. Apply the '90/5' Rule
  4. Appreciate Your Staff
A Physician Writes ─ 5 Ways to Improve  Physician-Patient Relationships (H&HN-Hospital & Health Networks)

Improved efficiency and effective patient engagement are often treated as if they are mutually exclusive. But through my experience as a physician and instructor, I have seen the power that several simple but fundamentally important skills can have on the physician-patient relationship. Rather than being an inevitable casualty of the changing health care environment, patient engagement is the road to improved efficiency, quality, safety and financial stability. Equipping everyone with the skills needed for success will improve culture, quality, patient experience, and provider and staff satisfaction as well as reduce physician burnout.

Your health care team members need five skills to restore relationships in their own practices:
  1. Presence and mindfulness.
  2. Reflective listening.
  3. Information gathering and agenda setting.
  4. Recognizing and responding to emotion.
  5. Gratitude and appreciation.
Taking the time to listen leads to better outcomes.

Palliative Care

Palliative Care Targets Quality of Life (Kiplinger)
This is an excellent overview article to give to those unfamiliar with palliative care facts and benefits. Includes perspective from cancer patient Amy Berman of The Hartford Foundation ("Palliative care is the best friend of the seriously ill."), Dr. Diane Meier, director of the Center to Advance Palliative Care ("Palliative care is appropriate at any age and at any stage in a serious illness and can be provided along with curative treatment."), and Judith Skretny, director of palliative care for the National Hospice and Palliative Care Organization ("Palliative care can be given to people anywhere.")
New Edition of Pediatric e-Journal Focuses on Communication (National Hospice & Palliative Care Organization & e-Hospice USA e-newsletter)

Communications with children and families is the theme of the new edition of the pediatric e-journal produced by NHPCO's Children's Project on Hospice/Palliative Services. This PDF resource is available free of charge online.

These articles included in this edition of the e-journal offer suggestions for and examples of engaging in this important aspect of providing pediatric palliative/hospice care.

Early Palliative Care Recommended for Cardiovascular Disease and Stroke Patients (AAHPM SmartBrief and tcdmd)
Patients with advanced cardiovascular disease and stroke should receive early palliative care, the American Heart Association and American Stroke Association said in a policy statement in the journal Circulation. The report included 28 recommendations to facilitate use of palliative care, covering reimbursement for services, the identification of patients who need palliative care, the creation of quality measures, the development of standards for hospital palliative care and education and certification for practitioners.
Systematic Palliative Care Provides Greater Improvement in Quality of Life for Patients with Pancreatic Cancer (Oncology Nurse Advisor)

Quality of life is significantly improved for patients with pancreatic cancer when systematic palliative care is administered vs on-demand palliative care, a study published in the European Journal of Cancer has shown.

Early palliative care (EPC) is proven to have a positive impact on clinical outcomes for oncology patients; therefore, researchers sought to determine optimal timing for EPC activation in a prospective, multicenter randomized study. 

Read more
End-of-Life Care
A Physician Writes ----   Mission Creep Doesn't Benefit Patients at the End of Life (Washington Post)

When my father was 88 and the picture of health for his age, he taught me, an experienced physician, an unexpected lesson.

We were discussing treatment options promoted by his primary-care physician and other doctors for an aortic aneurysm - a ballooned segment of blood vessel at risk for dangerous rupture in his abdomen. He turned to me and asked, "Why would I want to fix something that is going to carry me away the way I want to go?"

My father had the generally accurate impression that if his aneurysm ruptured, he could demand pain medicine, decline emergency surgery and be dead from internal bleeding within a few hours or, at most, a day or two.

With his unexpected question, he directly challenged the assumption that a doctor's advice is always in a patient's best interest, particularly regarding a medical problem late in life. This proposition had been my general belief, but after more than two decades as an internist and gastroenterologist, he had prompted me to reconsider it.

Furthermore, Dad was making an important distinction, between care at the end of life (in this case, palliative care for pain) and treatment (aneurysm repair). He was also suggesting a natural exit strategy. Not suicide, to which he had a moral objection, and not physician-assisted suicide, which was not a legal option in his home state of Wisconsin.

Despite his generally decent health, we both thought that he was too old for a major surgical repair, so I suggested he undergo an outpatient procedure to insert a stent to prevent the ballooning artery from worsening - that would at least postpone the threat of rupture. My reasoning was that with the stent, he was likely to enjoy the birth of his first great-grandchild and that without it, he would probably never know her.

My father lived five more years and met 12 great-grandchildren. Three of those years were good ones, but two of them were not.

I have asked myself, "Was it worth it?" I know that he asked himself that, too. His mantra for the last two years of his life was "I have lived too long."

Four Things Dying People Agree are as bad as or Worse Than Death 
(AAHPM SmartBrief and Quartz) 

Among seriously ill patients asked to consider dying or living with limitations, 69% said being incontinent would be as bad or worse than death, while 67% cited needing a breathing machine, 56% listed having a feeding tube and 54% said it was requiring constant care. Researchers noted in JAMA Internal Medicine that none of the patients had those limitations and it was possible they overestimated how difficult it would be to live with them.

Read more
"More At Peace": Interpreters Key to Easing Patients Final Days (National Hospice & Palliative Care Organization, e-Hospice USA e-newsletter and Kaiser Health News)
Interpreters routinely help people who speak limited English ----     close to 9 percent of the U.S. population, and growing ----     understand what's happening in the hospital. They become even more indispensable during patients' dying days. But specialists say interpreters need extra training to capture the nuances of language around death.

Many doctors and nurses need the assistance of interpreters not only to overcome language barriers but also to navigate cultural differences. Opportunities for miscommunication with patients abound. Words don't always mean the same thing in every language.

Medical staff, already nervous about delivering bad news, may speak too quickly, saying too much or too little. They may not realize patients aren't comprehending that the team can no longer save their lives.

"That's when it gets interesting," Maldonado said. "Does the doctor understand that the patient isn't understanding?"
Read more
Important Webinars Coming Up In September-October

September 15th and October 19th: Free Live Q&A Forums About the New Spiritual Care Association hosted by prominent health care chaplains the Rev. Sue Wintz, BCC and the Rev. George Handzo, BCC
Register for October 19th Forum

October 25th: "Advocacy for Spiritual Care in a Changing Political Environment" presented by Washington, DC expert M. Todd Tuten ─ Senior Policy Advisor, Akin Gump Strauss Hauer & Feld LLP 

October 27th: "Reforming Chaplaincy Training" presented by The Rev. David Fleenor, BCC, ACPE Supervisor, Director of Clinical Pastoral Education, Mount Sinai Health System 
Board Certified Chaplains: September 15th Is Deadline to Purchase at Reduced Price the New Standardized Clinical Knowledge Test

Three New Online Professional Education Courses Now Available at the Spiritual Care Association Learning Center


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