No matter who the patient is or where they receive healthcare, one thing everyone has in common is that at some point they will reach the end of their lives. How society engages around end of life care can be emotionally fraught, and is something that is still not common for people to discuss with their providers.
“Our group is trying to humanize healthcare as a whole,” says Dr. Matthew Gonzales, Chief Medical Information Officer at the Institute for Human Caring at Providence St. Joseph Health in Gardena, California. Doctors rarely have conversations with people about their end of life choices, he says. Those that don’t “get left in the gap,” and often end up receiving worse care.
End of life care costs
These conversations range from how people want to receive care after they are not able to make decisions for themselves or become incapacitated. They are especially important to have as end of life care costs represent up to a quarter of a person’s Medicare spending, and a massive new generation is entering that age group. Beyond that, starting a discussion early on to document preferences for end of life care means that patients will have put in place mechanisms to allow for the best care possible.
A large amount of the process is automated, Gonzales says, enabling providers to follow up once the ice of the conversation has been broken. Patients in a medical system who are over 65 and don’t have advance directives on file are detected and personalized videos are emailed to them. These educate them about the importance of the directives and help engender a conversation with their primary care provider about planning for their end of life care.
Gonzales says that these practices are working: the rates of emails opened and videos watched suggests these new methods of engagement are catching on. “We saw about 20% [watched the videos], and we saw an increase in advanced care directives 6%,” he says, noting that prior methods often garnered not even half of a percent in directives.
Person-centered care
Part of this is because of analytics. “It’s really important that however we deliver content, we need to get closer to person-centered care,” says Gonzales, who says his role in palliative care is centered around building bridges with his patients. “How do we have these conversations in the best way possible?”
Everything from delivering the video in the intended viewer’s native language to keeping the content short and making it clear that it’s a message coming from the viewer’s doctor has helped achieve significant buy-in from the test audience. Learning more about how patients engage with automated communications and conversations around end of life care will change much over the next few years, empowering a patient population that is soon to grow, Gonzales says.
“If we can make these conversations normal and embed them in the fabric of society, it will make it easier to talk about having a serious illness or be a caregiver for a loved one,” he says.
Dr. Matthew Gonzales will share some of The Institute for Human Caring’s practices at HIMSS20 in a session titled “End of Life Care: Helping Patients Make Tough Decisions.” It’s scheduled for Wednesday, March 11, from 10-11 a.m. in room W311E.
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