blowers.jpgClinical Connections interviews (pictured) Sarah Blowers, MSN, ANP-BC, RN ACHPN, Nurse Practitioner at Hospice of the Western Reserve, about the essential role of conversations in Advance Care Planning 

 

Q:  What are some of your chief responsibilities as a Nurse Practitioner for Hospice of the Western Reserve?
A:  I work on the Lakewood and Westlake teams to provide care for patients and their families in the home setting. Patients or their surrogates are able to select me as their attending of record for home hospice care. This allows us to work together to develop their plan of care and prescribe the necessary medications to provide the best quality of life through their illness trajectory. 

Q:  You mentioned you are especially passionate about the topic of advance care planning. Why?
A:  Effective communication is central to advance care planning (ACP). It enhances trust, builds meaning and empowers patients and families to take action. It allows for shared decision making based on the patient's values and goals, and allows their story to be heard and validated.  It heightens our team's ability to honor their wishes. It instills hope, reframes it and gives meaning to the relationship.

Q:  Can you provide a real-life example that illustrates the value of effective communications?
A:  One of our patients with metastatic cancer had completed the ADs, and had also had conversations indicating he did not want artificial hydration or nutrition. And he wanted to die at home. When he became unresponsive, his family began to struggle with him not being able to take anything in by mouth.  We were able to review his wishes via the ACP and documents and reassure family he had made the decisions, and that they were honoring his wishes. The family accepted the guidance of the documents and remembered the conversations. As a result, they were at peace when he died. 

Q:  How essential is the need to inform and educate individuals about the need to complete their advance directives?  
A:  It is important to complete Advance Directives (AD) as part of advance care planning. However, their completion alone does not ensure the healthcare team or patient have communicated values and goals.  A conversation that ascertains their understanding of their illness - including their hopes and worries - and shares this information within the context of their disease is essential to ACP process. However, ADs do provide a way to open conversations essential to aligning the goals of the patient with appropriate treatment plans.

Q:  What are your suggestions for other nurse practitioners who are working with patients earlier in the disease trajectory?
A:  ACP should be addressed intermittently during the illness trajectory as goals of care will change as illness progresses. When discussing AD, I have found it helpful to talk about it in a matter of fact way… that this is something I do with all my patients. I have also found the Serious Illness Conversation Guide to be an effective tool to provide a framework. It guides patients through the process and promotes informed decision-making so they can get the care they want without undue burden. 

Editor's Note: Sarah Blowers has served as a Nurse Practitioner at Hospice of the Western Reserve for more than four years.  With a career that spans more than 30 years in healthcare, Blowers graduated from Ursuline College with a Master's of Science in Nursing. She is a Board Certified Adult Nurse Practitioner and is Certified as an Advanced Practitioner in Hospice and Palliative Care.