Although many patients do not want aggressive care at the end of life (EoL),1 such care is not uncommon2 and may be associated with poorer quality of life and psychological distress.3 Advance care planning (ACP) permits patients to express preferences for EoL care and increase concordance between care that is desired and care that is delivered at EoL.4 Rather than waiting for an urgent health crisis, regular office visits are a preferred time for ACP discussions.4 With the new Centers for Medicare policy, lack of reimbursement for time spent in ACP discussions should no longer be a barrier to conducting them.5 However, other structural (eg, competing demands) and professional barriers (eg, lack of training) remain.6 These persistent barriers suggest consideration of nonphysicians for such discussions.5 Board-certified chaplains have training and experience in discussing EoL preferences with patients and families. The aim of this pilot quality improvement project was to determine whether having a board-certified chaplain conduct ACP conversations with patients in the physician’s office would be feasible, effective, and acceptable to all stakeholders.
Lee AC, McGinness CE, Levine S, O’Mahony S, Fitchett G. Using Chaplains to Facilitate Advance Care Planning in Medical Practice. JAMA Intern Med. Published online January 16, 2018. doi:10.1001/jamainternmed.2017.7961
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