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PHM Focus

Schedule at a Glance

Difficult Conversations Made Manageable: How to Approach Advanced Care Planning Discussions and Ethical Dilemmas at End of Life

Primary Leader:
Rachna May

Co-Leaders:
Christine Traul
Michelle Marks
Hank Puls

Objective 1:
Review the evidence supporting why advanced care planning is important for both families and hospitalists

Objective 2:
Review the appropriate times for hospitalists to initiate these discussions

Objective 3:
Review palliative care literature specific to the pediatric hospital medicine patient population

Summary:
Hospitalists continue to care for increasing numbers of children with medical complexity. This population accounts of a large percentage of readmissions and overall, tends to have longer lengths of stay. Accordingly, hospitalists are well positioned to help families make difficult decisions surrounding their child's healthcare needs. The literature shows that these conversations are most effective when correctly timed in relation to the child's health and when the healthcare provider has an understanding the barriers that may arise. This workshop aims to make these challenging conversations easier by reviewing evidence and techniques on how to handle these difficult situations. Participants will discuss six cases focusing on three areas - discussing care goals, transitioning to comfort care, and ethical dilemmas at end of life. Methods for structuring these discussions, such as the modified SPIKES method for pediatrics, will be reviewed.