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Grey Nuns Community Hospital, Canada
Title: Integrating Advance Care Planning Education Early in Cirrhosis Care: An Inter-Disciplinary Model to Increase Uptake
Biography

Dr. Brisebois is an active member of the Internal Medicine community, and has been an Attending physician on the Grey Nuns Hospital inpatient medicine units since 2000. She graduated from Medical School from the University of Calgary in 1995. After attending a first year of residency at the Mayo Clinic, in Rochester Minnesota. She returned to Canada to complete her Internal Medicine residency, as well as completing a year of Oncology training at the University of Alberta. After experiencing multiple years of helping patients live with chronic illness, she returned to do a year of added competency in Palliative Care which was completed in 2012 in Edmonton. She spent 2012-2013 working both on the Palliative Care Consult Service at the Royal Alexandria Hospital and the Palliative Care Unit at the Grey Nuns Hospital. Currently, she is focused on helping non-cancer patient populations, live well with better symptom control and understanding of how disease progression impacts a patient’s life. She founded PPRISM, a non-cancer palliative care outpatient clinic, which is located in the Kaye Edmonton Clinic at the University of Alberta. She is thrilled to now have adjunct appointments in the Division of Palliative Care and the Division of Internal Medicine, as she is actively involved in caring for patients in both of these domains. Dr. Brisebois is deeply involved in Provincial Networks and co-chairs the Strategic Care Network Committee for Palliative Care Pathway and Guidelines. She is passionate about furthering Provincial education opportunities for families and practitioners, and continues to promote a wider understanding of palliative services in Alberta.

Abstract

Advance Care planning (ACP) and goals of care designation (GCD) are being increasingly discussed amongst specialists and generalists involved in the care of patients with cirrhosis. Uptake and adoption of integrating these discussions into standard inpatient and outpatient care have been limited with physicians citing many perceived barriers and limitations. Based upon the literature evidence-base and our experiences, we provide an actionable framework that can be readily implemented into a busy clinic setting, or in in-patient populations, suitable for use by any practitioner. A set of two educational pamphlets, including an ACP cogwheel and figures explaining the course of chronic illness have been implemented. Discussions have involved both a Palliative Care (and Internal Medicine) specialist and a Gastroenterology specialist or General Medicine specialist, as well as an inter-disciplinary team, the patient and their surrogates. The percentage of patients with ACP and GCD documentation has increased dramatically during this time. The use of a formalized process, visual aids, educational pamphlets, has been integrated into care in both the outpatient and inpatient settings. These tools can be customizable based on the underlying gastroenterological (GI) disease, and are hoped to be conversation starters in many clinical settings. In our practice, this assemblage of “best practice tools” has increased the number of outpatients with cirrhosis, and other GI chronic illnesses, who have actively contributed to their GCD prior to acute health events and are supported by well-informed surrogates. We have shown significant value of inter-disciplinary outpatient clinics to educate health practitioners and patients, and wish to promote this globally.

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