One of the many effects of the current COVID-19 pandemic has been the recognition of the necessity for advance care planning and the benefits of doing so. More patients are dying every day in isolation and suffering from serious illnesses.
As of this writing, the National Vital Statistics System of the U.S. Centers for Disease Control and Prevention reported over 50,000 deaths and over 800,000 confirmed cases throughout the nation. The pandemic has not only increased the volume of patients in need of hospice and palliative services but also impacted how patients are receiving care in their final days.
“Advanced directives really are an opportunity,” said Theresa Younis, chief administration & integration officer of end-of-life care Hospice Care of South Carolina/Agapé Hospice in an interview with Hospice News. “Planning ahead mitigates stress, disagreement, anxiety, and remorse for patients and family members. It’s important to understand that decisions like these are best made before there is a health crisis and that providers realize advanced care planning is not a single conversation. It is a conversation that happens over time that patients and families may change as their situations change. With the losses that we’ve felt in this country with COVID-19, this might be the turning point and a pivotal point for end-of-life discussions.”
A popular health-care decision-making tool used by physicians to give unfavorable medical news to a patient is a six-step protocol named SPIKES. SPIKES is an acronym for the six components of setting, perception, invitation, knowledge, emotion, and summation. Traditionally, it is used to guide difficult conversations with patients and families with the intent to gather information from the patient, transmit the medical information, provide support to the patient, and elicit the patient’s collaboration in developing a strategy or treatment plan for the future.
The tool highlights the important elements to consider in end-of-life care such as a private setting, assessing the patient’s perception of their situation, and offering them more information to increase their understanding, and determining a strategy to proceed based on their wishes and mindset. Some hospices such as VITAS Healthcare, a hospice care service in 14 states and the District of Columbia, are using SPIKES to jumpstart end-of-life conversations.
Using SPIKES as a guide, end-of-life experts recommend taking these steps now to make sure your wishes are known and carried out if you are diagnosed with a terminal disease or are approaching death and cannot speak for yourself:
- Setting—Choose a private setting where you can sit face-to-face with the patient and a family member or confidant. If the patient does not speak English, rely on a professional interpreter rather than a family member.
- Perception—Ask the patient how much they know, perceive, or suspect before you begin the conversation.
- Invitation—Subtly invite the patient to provide clues about the willingness to receive more information. Ask if they would like to talk about test outcomes, treatments, etc. If the patient does not respond favorable, suggest that you talk again later that day or the next. Then follow through.
- Knowledge—Share information directly and simply. After you’ve opened the conversation, stop talking. Listen to the patient’s responses and emotions.
- Empathy—Identity with the patient’s emotional reaction in a kind way that suggests you understand and appreciate their response and are concerned about their future.
- Summation—Summarize the news and recommend hospice care.
“Having these end-of-life discussions often helps open the door to broader conversations about what’s important to people,” Joseph Shega, M.D., senior vice president and chief medical officer, VITAS Healthcare, said in an interview with Hospice News. “And as you start into those conversations, it often becomes clear that their goals really are consistent with hospice. Starting that conversation helps to open their eyes about what kind of care they do and don’t want, and what type of care best supports those wishes.”
Hospice providers can be a great resource for patients and their families to develop strategies for advance care planning at any time during a patient’s illness but especially now, in the face of this pandemic.