Anyone could be faced with unexpected medical conditions, unable to communicate their health care decisions, so it is important to have plans in place ahead of time to ensure a patient’s wishes are being honored—particularly in a nursing home setting.
With the online training they developed specifically for nursing home staff, Susan Hickman and her Indiana University School of Medicine colleague Kathleen Unroe are providing foundational information regarding advance care planning. This involves discussing a patient’s values, goals and treatment preferences for medical care to prepare them for future communication and decision-making.
Designed in collaboration with nursing home partners, the training has a specific focus on working with patients with Alzheimer’s disease and other related dementias and their family caregivers, who are often asked to make important care decisions. The training has been used by hundreds of nursing home staff around the country to support nearly 6,000 conversations with residents and their family members.
“Advance care planning not only reduces family caregiver stress but improves patient satisfaction,” said Hickman, a Cornelius and Yvonne Pettinga Professor of Medicine at the IU School of Medicine and director of the Center for Aging Research at the Regenstrief Institute. “However, there are minimal training resources available that are specifically for nursing home staff. The result is that these important conversations tend to be overlooked or approached in a problematic way that can be detrimental for the patient.”
The online training provides information on advance care planning, decisional capacity and supporting informed decision-making, along with tools to help staff engage in these conversations with residents and families.
Hickman, whose research focuses on optimizing the quality of life for older adults by improving communication and decision-making to honor a patient’s treatment preferences, emphasized the importance of proactively having these conversations, particularly in instances when a patient is unable to speak for themselves.
“Failing to proactively discuss preferences and goals can result in burdensome hospitalizations and result in decisions that do not reflect the patient’s treatment goals or preferences, especially during times of crisis when fast decisions-making is required,” Hickman said.
The training includes a facilitation guide with standardized questions to help nursing home staff approach the topic with sensitivity and clarity. Organizational documentation tools are also provided, including a tracking sheet and an example workflow overview to refine and improve advance care planning practices.
“There was a critical need for sustainable training for these facilities,” Hickman said. “We created these resources so that nursing home administrators do not have to reinvent the wheel every time they hire someone new.”
In addition to advance care planning, Hickman also works on POLST: Portable Medical Orders, a medical form used across the country to document treatment preferences for resuscitation and medical interventions as actionable medical orders that emergency medical services can follow. According to Hickman, the form is crucial as it improves the continuity of care for patients and allows for their treatment preferences to be respected.
Hickman has partnered with the IU Innovation and Commercialization Office to further her research.
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