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:

What is the goal of admission?
What is the chance of surviving one year?
Has the prognosis been discussed?
What does the patient think of this prognosis?
What are the patient's wishes for care?
Which treatments would the patient undergo to prolong life?

Table 5.2 Effect of Care Plan Discussion and Document (CPPD)
Control Group	Intervention
8 patient charts	19 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 orders	5 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 ].