conducting meaningful care 3/11/2021 conferences: how to
TRANSCRIPT
3/11/2021
Conducting Meaningful Care Conferences:
How to conduct the care conference.
Emma Bjore, MD Soo Borson, MD
Disclosures
• Soo Borson, MD• No disclosures
• Emma Bjore, MD• No disclosures
Outline
• Review• What is a care conference?
• When is the right time to have a care conference?
• Case Demonstration• 4Ms summary
• Role Play
• 4Ms care plan
• Communication considerations
• Summary
Review: What is a care conference?
• A meeting with a patient, their support people and care providers to develop or revise a plan of care, led by a health care professional. • Components
• Lead introductions - all participants
• Provide updates on medical condition
• Solicit clarifications, concerns, questions from patient/caregivers
• Elicit what patient wants – big-picture personal/health goals, values and preferences
• Suggest potential action options, elicit responses, and collaborate to develop care plan (attend to number and burden of actions)
• Summarize plan
• Establish how follow up will occur
Review: When to have a care conference?
• New life-altering diagnosis
• Change in health status
• Need for support services and resources
• When requested
• Expanded• When caregivers can be present
Case demonstration
• Ms. Cornwell is a 71 year old seen in clinic with her son after a fall at home last week. She has had 12 falls in the last six months – 5 led to 911 call and ED visits. Son lives in Ohio.• PMHx: Mild cognitive impairment, COPD, incontinence, chronic back pain,
visual impairment, hearing impairment, osteoporosis, insomnia
• Medications: oxygen at night, albuterol prn, oxybutynin, Advil, amitriptyline
• Social Hx: divorced, two children, educated, lives in a house alone, drinks two glasses of wine every evening
• Functional status: Walks with a cane at times, manages ADLs, requires assistance with some IADLs
Case demonstration4Ms summary • Matters
• ?
• Mentation• MCI, alcohol use
• Medication• High risk medications
• Mobility• Walks with or without cane, frequent falls
Case demonstration: Role Play
• Take one
Case demonstration
• What did you notice?
• What could have been improved?
• Was that a helpful care conference?
Communication considerations
• Couple hopes with concerns – “I’m hoping…I worry about…”
• “I” statements – you’re invested too
• Promote partnership – key to continuity of care and positive influence
Case demonstration: Role Play
• Take two
Case demonstration
• How was this different?
• What went well?
Case demonstration4Ms collaborative care plan • Matters
• Avoid falls, fracture and maintain independence• Ensure son manages caregiver stress, regular updates from MD, join a WyCOA
caregiver support program, recruit home health support
• Mentation• Cut back on alcohol use, minimize centrally acting medications, increase physical
activity
• Medication• Discontinue oxybutynin and amitriptyline, work on bladder training and sleep
hygiene, replace ibuprofen with acetaminophen for back pain
• Mobility• Use cane always, increase safety awareness around oxygen tubing, start physical
therapy at home and exercise plan to improve balance and decrease back pain
Summary
• Softer communication promotes partnership, evokes empathy and provides hope in care conferences
• Planning care with the patient and care partners is key
• The 4Ms framework helps organize the process
References
• Lakin, Joshua et al. Softening Our Approach to Discussing Prognosis. JAMA Internal Medicine. January 2019. Volume 179, Number 1
• Brull, Jen. Advance Care Planning: How to Have the Conversation You Want With Your Patients. AAFP. November 2019.
• Egnew, Thomas. The Art Of Medicine: 7 Skills That Promote Mastery. AAFP. 2014