Improving Care for the End of Life, Online Edition The Palliative Care Policy Center

Sourcebook : 5.5 Educate Clinicians and Community Leaders about Effective Advance Care Planning : 5.5.2 Case Study - University of California at Los Angeles

The UCLA Breakthrough Series team developed a tool that encourages doctors to talk openly to patients about their illness, its progression, and their preferences. The one-page Care Plan Discussion Document (CPDD), written and refined over several months, can be completed in a few seconds once the issues have been discussed (see below).

The CPDD asks providers to note several aspects of the care being provided to a dying patient and includes material helpful for medical social workers. The tool aims to stimulate discussions earlier in the course of the illness and provide a structured method to document that conversations have occurred. The multiple-choice form addresses the following questions:

Table 5.2 Effect of Care Plan Discussion and Document (CPPD)
Control GroupIntervention
8 patient charts19 patient charts
No discussion of prognosis
or preferences on medical records
11 completed CPDD; of these:
  • 7 discussed prognosis
  • 4 discussed preferences
  • 5 discussed resuscitation
2 discussed/wrote DNR orders5 completed DNR orders
Reprinted with permission of UCLA Medical Center, Los Angeles, CA

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This online version of the book Improving Care for the End of Life: A Sourcebook for Health Care Managers and Clinicians is provided with permission of Americans for Better Care of the Dying [ www.abcd-caring.org ] and Oxford University Press. All rights reserved.

For further information on quality improvement in end-of-life care visit The Palliative Care Policy Center [ www.medicaring.org ].

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