Helping seriously ill patients discuss end-of-life wishes

A program launched by Ariadne Labs, a joint center of innovation between Brigham and Women’s Hospital and Harvard T.H. Chan School of Public Health, is helping clinicians initiate conversations with their seriously ill patients around their preferences for end-of-life care.

The Serious Illness Care Program includes guidance in identifying patients before crises occur, and suggests questions to ask patients such as “How much are you willing to go through for the chance of gaining more time?” Rachelle Bernacki, the program’s associate director at Ariadne Labs, co-authored an article published December 1, 2016 in Harvard Business Review describing efforts to expand the program from primary care to hospital settings.

In a randomized trial at the Dana-Farber Cancer Institute, more than 90% of patients whose physicians had been trained in the program had an end-of-life conversation, as compared to 70% of patients whose physicians were not trained in the program. For patients under the care of the trained physicians, these conversations happened an average of three months earlier, and were more than twice as likely to be focused on the patient’s experience and wishes (95% vs. 45%), and accessible on patients’ electronic records (68% vs. 28%).

Bernacki and co-authors wrote that “having the conversation lowered patients’ anxiety, and patients reported that their hopefulness remained steady, while their sense of control over medical decisions increased.”

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Ariadne Labs, a center for health systems innovation, launches new space (Harvard Chan School News)