Inadequate communication about serious illness care preferences affects patients, families, health care providers, and health care systems. Many patient and system barriers prevent comprehensive serious illness communication. The purpose of this evidence-based practice project was to provide a structure within a primary care clinic to facilitate conversations with seriously ill individuals about their care preferences that (a) was adaptable to clinic workflow, (b) improved providers’ perception of the care conversation experience, (c) improved documentation of care preferences, and (d) provided a comfortable and helpful experience. The Johns Hopkins Nursing Evidence-Based Practice model and Serious Illness Care Program were used to address provider and system barriers to conversations about care preferences. Program interventions included training providers and staff; identifying patients at risk for high symptom burden and mortality; integrating system interventions; and evaluating outcomes. Providers completed training, after which a 5-week pilot practice change was conducted. Provider perceptions of conversations after implementation were positive. During the pilot, 3 serious illness care conversations were initiated with additional patients prepared for future conversations using an information sheet and introduction to the conversation.
Jill A. Massmann DNP, APRN, CNS, AGCNS-BC, OCN, ACHPN, is a palliative care clinical nurse specialist, St. Cloud Hospital; and was DNP student (during project implementation), Department of Nursing, Winona State University, Rochester. Minnesota.
Sara S. Revier MSN, APRN, CNS, ACNS-BC, ACHPN, is a palliative care clinical nurse specialist, St. Cloud Hospital, Minnesota.
Julie Ponto PhD, APRN, CNS, AGCNS-BC, AOCNS, is professor and AGCNS program coordinator, Department of Nursing, Winona State University, Rochester, Minnesota.
Address correspondence to Jill A. Massmann, DNP, APRN, CNS, AGCNS-BC, OCN, ACHPN, St. Cloud Hospital, 1200 6th Ave N, St. Cloud, MN 56303 (firstname.lastname@example.org).
The authors have no conflicts of interest to disclose.
Online date: March 20, 2019