Introducing a Supportive Care Team for Advance Directive Education in a Neurological and Neurosurgical Patient Population

Abstract

Background: Patient-centered care includes delineation of patient treatment values (ie, advance care planning [ACP]). Advance care planning often includes advance directive (AD) completion and is underutilized, particularly among neurology and neurosurgery patients. Implementation of a supportive care team (SCT) in outpatient clinic settings may offer opportunities for AD education and completion. Objective: This study assesses the effectiveness of an integrative SCT composed of hospice volunteers and undergraduate quality improvement interns in their efforts to provide ACP education in neurological and neurosurgical outpatient clinics. Assessment includes a description of different types of SCT-patient encounters, as well as patient interest in and completion of ADs after interacting with the SCT. Results: Across the data collection period, 2770 encounters were initiated. The majority of encounters resulted in patient ACP education. Some patients completed ADs during their SCT encounter (3.45%) or after their SCT encounter (10.18%). Conclusion: The SCT effectively enhances ACP education in this patient population. The utilization of trained interns to assist with ACP is beneficial and practical in clinic workflow.

Palliative Care Services in the NeuroICU: Opportunities and Persisting Barriers

“…5 At the same time, few neurology and neurosurgery patients engage in consideration of goals of care (e.g., advance care planning) in advance of rapid health decline. 16 Despite benefits of palliative care in addressing these issues, palliative care consultation has been reported to be requested in less than a quarter of patients, 5 and palliative care services for critically ill neurology and neurosurgery patients is understudied. 17 One main barrier to palliative care and hospice service utilization in NeuroICU settings may be delay in referral to such services.…”