Any outsider listening to the phone conversation that occurred this summer between Kelly Taylor, director of quality improvement at Mercy Clinics, Inc. in Des Moines, Iowa and Jane Price, the lead nurse for patient experience at Aneurin Bevan Health Board in Gwent, Wales, would have thought they were listening to old friends exchanging stories about a shared history of palliative care nursing. Although they had never met in person, this first conversation between the two was a seamless exchange of personal anecdotes, lessons learned from their work, and hope for the future of health care for those suffering from terminal disease.
Jane, who lives and works in Wales is a recipient of a Florence Nightingale Dignity in Care travel scholarship, which offers nurses the opportunity to broaden their professional development through travel to other countries to observe different care delivery systems. She spent three weeks in June visiting Dartmouth-Hitchcock Medical Center (DHMC), an Informed Medical Decisions Foundation supported shared decision making (SDM) demonstration site, where she gained a comprehensive understanding of DHMC’s current SDM implementation models and was able to spend time with clinicians, including the palliative care team. Jane also spent a day in Boston with our staff talking about end of life decisions and our decision aid programs on the topic.
After her visit to the DHMC and our office, Jane was eager to learn more about how she could adapt models of SDM to her own work supporting patient wishes regarding where they spend their last days. Meg Bowen, Foundation implementation manager, decided to orchestrate a phone call between Jane and Kelly to give her another example of how SDM is implemented at another one of our demonstration sites. Kelly is one of the guiding forces behind the new Transition Coaching model at Mercy Clinics, Inc., also one of our demonstration sites. Transition Health Coaches are nurses with advanced training in both motivational interviewing and decision support who start the conversation with chronically ill patients about making choices regarding end of life care.
“I knew these two ladies would have a lot of information to share, and I thought they both would hit it off and form a fast friendship,” says Meg. “As patients live longer many are suffering from progressive diseases and the opportunity to involve patients in decision making around end of life care is more important now than ever.”
What transpired on the call was a beautiful conversation about the struggles to implement SDM in settings where death can still be a taboo subject. Kelly was able to share the lessons learned around implementation and training, and Jane was able to share lessons from her work in Wales, which includes working collaboratively with clinicians to enhance a patient-centered care model for chronically ill patients. Each relayed stories full of emotion, detailing how patients were often relieved that someone had “finally brought up the subject” of death and dying, and how they helped patients navigate the system in order to make sure their wishes were honored.
Ultimately their conversation illustrates the continued need for patient involvement in end of life decisions.“Patients have time to think about what they want, and [they] need an active ear to listen and help honor their wishes surrounding end of life. These two women, both on other sides of the world are doing just that,” says Meg.