IHI says failure to respect end-of-life wishes is a patient safety issue
A white paper released by the Institute for Healthcare Improvement (IHI), "Conversation Ready: A Framework for Improving End-of-Life Care” is an update to the original 2015 white paper addressing end-of-life discussions – or lack thereof – that healthcare professionals have with their patients, family and other loved ones. But more than a discussion, the IHI encourages providers to use the document as a tool to improve end-of-life care, something they say is detrimental to patients when delivered poorly and should be viewed as a safety matter in need of attention.
"The failure to respect patients’ wishes regarding end-of-life care can lead to harm — including emotional, psychological, socio-behavioral, and financial harm — meaning that poor end-of-life care is a safety issue," states the IHI’s April 10 blog.
The IHI says the tool is still in the early stages of testing but by asking healthcare providers to consider how they treat patients who are close to death could be “a powerful, if limited, way to drive improvement.”
The organization say engaging patients in thoughtful advanced care planning (ACP) can lead to improved quality of life, care that is more consistent with patient preferences, and better bereavement outcomes for the family. In response to the question that end-of-life discussions could cause patients to feel hopeless about a possible recovery, IHI points to a study conducted by the American College of Physicians High Value Care Task Force and others that provide strong evidence that shows patients do not experience increased depression, anxiety, or hopelessness when care teams initiate ACP.
“Even if attempts to engage patients in the ACP process do not always lead to specific decisions, they may be an important way of building trust and relationships among patients, families, and health care professionals, and may also be helpful for making future decisions. ACP is thus recommended for all patients with serious illness,” wrote the white paper authors.
The updated white paper focuses on the following:
· Defines five interconnected Conversation Ready principles
· Calls out the consequences of inadequate advance care planning and disrespectful care as forms of preventable harm
· Guides readers through an in-depth examination of the concepts that underlie the Conversation Ready work and the factors that contribute to unreliable advance care planning
· Encourages taking a systems perspective to build more reliable processes for advance care planning and providing respectful care at the end of life
· Provides recommendations about where and how to begin, including examples of changes other organizations have tried and suggested measures.
