Competent Systems: Supporting Communities and Professionals at the Systems Level
Change also needs to happen at the system level in healthcare so that ACP fits seamlessly into the standard workflow. One positive example is UCLA Health, which has undertaken a system-wide Advance Care Planning Initiative (ACPI) aimed at creating and fostering a culture, skills, and infrastructure within the organization that supports effective and compassionate communication, reliable documentation of preferences and goals, and high-quality serious illness care. As part of this work, UCLA hired CCCC to help them create an ACP curriculum for UCLA’s staff using CCCC’s “Let’s Talk” curriculum as a foundation. UCLA is using the curriculum to provide:
- Training for care coordinators to use with patients in primary care clinics to introduce consideration of goals of care and lay the foundation for conversation with a physician;
- Training for physicians on how to conduct ACP conversations; and
- Deep dive training for specialized staff, such as a palliative care nurse practitioner embedded in UCLA’s Oncology clinic and an ACP social worker embedded in the Cardiomyopathy clinic.
CCCC is also working with UCLA, with the participation of UCSF and UC Irvine, on a multi-pronged, multi-year research study funded by the Patient-Centered Outcomes Research Institute (PCORI). The study is examining the degree of proactive support required from the healthcare system to increase patient engagement in ACP. Interventions range from the introduction of an advance directive, an advance directive plus engagement with the PREPARE for your Care website, or those two interventions plus the addition of a dedicated care coordinator to assist patients and caregivers with their ACP. CCCC is working with the study team at all three institutions as well as with a Community Advisory Committee, comprised of a small group of patients, to ensure the patient voice is included in the study.
Making Long-term Impact to Support Patients and Healthcare Professionals
ACP is an ongoing process that supports adults at any age or stage of health in understanding and sharing their personal values, goals, and preferences regarding future medical care. It helps ensure that the care delivered to patients is in accordance with the care they desire, mitigates the burden of unwanted healthcare interventions, and provides peace of mind for providers, patients, and loved ones. CCCC’s goal is to make the ACP process a part of everyday life so that all adults have the information, support, and time they need to think about and make decisions that are right for them. We are dedicated to driving this important work forward, and we are excited to develop new and creative opportunities to work collaboratively with local coalitions, healthcare organizations, and individual providers to strengthen and support the ACP ecosystem and achieve our goal.