Frequently Asked Questions
- What is Honoring Choices Virginia?
- Why is it important?
- What is advance care planning?
- Why is the Richmond Academy of Medicine interested in advance care planning?
- What is the Academy asking health care systems to do?
- What do the pilots look like?
- What will community outreach look like?
- What are the consequences of this project?
- What is the Academy’s role in the project?
- How can we measure success?
- What does an effort like this cost?
- How can I start the conversation with my doctor, family and loved ones?
1. What is Honoring Choices Virginia?
Honoring Choices Virginia is a major initiative to build system change, advocacy and education around advance care planning. Through Honoring Choices Virginia, the Richmond Academy of Medicine serves as convener, coordinator and catalyst to build clinical improvements combined with outreach in healthcare systems and communities across our region.
Honoring Choices Virginia is modeled after Honoring Choices Minnesota, a project of the Twin Cities Medical Society, and Respecting Choices® First Steps®, a pioneering program in advance care planning based in La Crosse, Wisconsin.
2. Why is it important?
Starting a conversation about end-of-life care is difficult for all of us, whether we are physicians, patients, family members, religious and community leaders or other health care professionals. It is, however, imperative that these conversations happen. And once they occur, it is equally critical that patients’ choices are honored by those who care for them.
3. What is advance care planning?
Advance care planning is a process across time of understanding, reflecting on and discussing future medical decisions, including end-of-life preferences. Advance care planning includes:
• Understanding your health care treatment options.
• Clarifying your health care goals.
• Weighing your options about what kind of care and treatment you would want or not want.
• Making decisions about whether you want to appoint a health care agent and/or complete an advance directive.
Communicating your wishes and sharing any documents with your family, friends, clergy, other advisors and physician and other health care professionals.
4. Why is the Richmond Academy of Medicine (Academy) interested in advance care planning?
Richmond has had champions for advance care planning, hospice and palliative care for years. The Academy recognized, however, that advance care planning still is not the norm for physicians, patients and their families, and looked for ways to meet the enormous need for improvement.
5. What is the Richmond Academy of Medicine (Academy) asking health care systems to do?
The Academy is building collaboration around facilitating advance care planning conversations and honoring patients’ decisions throughout care.
To participate in the project, health systems agree to:
• A common emphasis on improving the conversation across health systems and communities throughout Central Virginia.
• A common advance directive form and other informational materials.
• Train staff in the Respecting Choices® First Steps® program.
• Devote organizational resources to a pilot project.
• Share lessons learned from their experiences formally and informally.
• Capture consistent quality measures.
• Shared community outreach under the umbrella of the advance care planning project.
• Contribute financially to the Honoring Choices Virginia initiative.
6. What do the pilots look like?
Honoring Choices Virginia coordinated six-month pilot projects in 9 sites across three health systems in Central Virginia, which began in January 2015.
Participants provided facilitated advance care planning conversations to patients in a targeted demographic. The approach is based on the principles of Respecting Choices® First Steps®, a pioneering organization in advance care planning based in La Crosse, and participants and facilitators are trained by Respecting Choices® staff.
• Sites target a chosen demographic (e.g., patients 60 and older, patients with hypertension).
• Patients are offered a facilitated advance care planning conversation conducted by a nurse, social worker, chaplain, volunteer or other staff, under the guidance of a physician.
• Documentation of the conversation is entered consistently into electronic health records.
• Site leaders and facilitators are trained by Respecting Choices®. (Training and consultation for the first round of pilots began in September 2014, with facilitator trainings conducted in December 2014. Round 2 participants began training in Fall 2015.)
• Measurement metrics include the number of patients offered facilitations, number of conversations conducted and number of new advance directives entered into the medical record.
• Participants share lessons learned formally and informally, engage in monthly meetings and report findings.
The trial implementation provides participants the experience necessary to implement advance care planning systems across their organizations. The Society funds a substantial portion of the trainings; participation also requires internal costs, which vary depending on size and structure.
7. What will Community Outreach look like?
After clinical implementation is under way, Honoring Choices Virginia will launch a major grassroots effort to reach residents through media, multicultural organizations, senior centers, support networks and other venues. Community, religious, senior and other leaders will be engaged in this project from the beginning. It is particularly important to us that we reach Virginia’s underserved populations.
8. What are the consequences of this project?
We believe this coordinated effort around advance care planning will result in:
• Improved understanding of advance care planning, hospice and palliative care among physicians, other health care professionals and patients.
• Higher advance directive completion rates.
• Significant improvement in end-of-life care.
• Fewer hospital readmissions and patient intensive care unit days and increased hospice utilization.
• Greater satisfaction among family members after the death of a loved one.
• Greater public awareness of and demand for advance care planning.
9. What is the Academy’s role in the project?
The Academy serves as convener, coordinator and catalyst for Honoring Choices Virginia. To facilitate this approach, the Academy:
• Engages physicians on the importance of advance care planning.
• Organizes design and implementation, facilitator and instructor training courses.
• Helps participants form pilot teams and develop their work flow.
• Provides a forum for information sharing.
• Drives community involvement and education.
• Publicizes the project and its participants.
10. How can we measure success?
In the short term, we can measure the number of patients offered facilitated conversations through the initiative, the number of conversations conducted and the number of new advance directives entered into the medical record. Over the long term, we can track increases in the number of conversations and advance directives completed across the health care system, the number of days patients spend in the hospital, intensive care unit and hospice in their last days of life, and satisfaction and depression rates among family members after the death of a loved one.
11. What does an effort like this cost?
An effort of this magnitude requires significant resources: $400,000 for training, staff and outreach in the first two years. Grassroots community and media efforts, once launched, will require additional resources in future years.
12. How can I start the conversation with my doctor, family and loved ones?
Starting the conversation can be difficult, and the Academy hopes to help people have the courage and ability to speak with their family members and health care professionals. For tips and resources to help you get the conversation going, click here.
© (2012), Gundersen Lutheran Medical Foundation, Inc. Licensee may copy and modify copy document.
The name “Honoring Choices Virginia” is used under license from East Metro Medical Society Foundation. 2012/13-G