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)|
|8 patient charts||19 patient charts|
|No discussion of prognosis|
or preferences on medical records
|11 completed CPDD; of these:
|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 ].