The right Comprehensive Advance Care Planning (CACP) program can be transformative for clinicians that manage patients with serious illnesses. When done correctly, CACP can be of tremendous value to both clinicians and the patients they serve — and it’s worth getting it right.
Given that the current clinician-led CACP model proves to be difficult in delivering widespread patient participation, practices should look to implement dedicated advance care planning (ACP) programs for their patients through a trusted CACP partner such as Iris.
Below are the 4 key elements that Iris CACP can provide to your practice and patients.
1. The Right Support at the Right Time
It’s crucial that seriously ill patients receive the right level of support at the right time. Rather than waiting until the end of a patient’s care journey to initiate CACP discussions, research has shown that early ACP interventions yield bigger benefits for both clinicians and patients.
The New England Journal of Medicine found that seriously ill patients who received early palliative care — of which ACP is a critical service — achieved:
2. In-depth Conversations
At its core, CACP is deeply human. Exploring a patient’s core values takes guidance, compassion, and patience, and synthesizing this information into concrete care goals is a complex, individualized process.
Unfortunately, clinician’s internal resources often lack the time and training to conduct CACP thoroughly for each patient and their loved ones.
While some clinicians state that they offer CACP services in their office, the services often are not as robust as they could, and should, be. Key questions for evaluating the robustness of CACP services include:
These considerations directly influence how thorough and personalized the CACP process will be, making them vitally important to individuals and their families as they evaluate their options.
3. Document Validation & Processing
Ensuring that advance directives are completed in accordance with state and federal guidelines and distributed to the point of use can be the deciding factor in whether or not an individual’s care wishes are actually carried out.
Iris documentation specialists are:
Additionally, a high-quality ACP program should go above and beyond the standard documentation required by state and/or federal law, adding supplementary notes and documentation to describe patient wishes in more detail.
Iris’ documentation specialists ensure that all documentation is executed correctly and completely, and then shared widely to patients, family members, caregivers and clinicians for future use. Without meticulous attention to detail during this important step, patients and their loved ones risk all of their hard work being disregarded when it matters most — a potentially devastating consequence that can and should be avoided from the outset.
4. Ongoing Conversations and Documentation Updates
It is rare that clinicians or care managers follow up with individuals about their ACP decisions throughout their care journey. But the truth is, ACP should not be a one-and-done process. Instead, it should be an ongoing conversation that accounts for the changing variables that influence one's goals of care, including:
Iris’ high-quality CACP program provides continuous outreach by facilitators, proactively helping patients revisit and revise their goals of care over time.
When it comes to ACP, not all care plans are created equal. Iris specializes in creating high-quality, personalized care plans for each patient and their unique goals and wishes. Iris’ team of trained ACP experts ensure each of the four elements above are accounted for in every care plan, providing patients with a tailored and person-centered experience.