Talking about death is difficult, especially for physicians who need to discuss planning for the end with patients. Dr Marnie Jacobsen of Trail had been delicately raising the subject with her patients for many years, but now she is equipped with new skills and tools to confidently discuss the matter thanks to an innovative program for BC doctors.
“People don’t want to think about dying, but most have a fairly good idea of what they do or don’t want done to them at the end,” says Jacobsen. “Physicians need to understand which patients are reaching the end of their life and open the conversation while these patients aren’t in crisis, but in a more planned and less emotional situation. This gives patients the opportunity to think about what they really want.”
Jacobsen was one of the first BC family physicians to put into practice the lessons, tools, and resources of the End of Life module, a recent offering from the Practice Support Program (PSP). The PSP is a joint initiative of Doctors of BC and the Ministry of Health that provides training and support for physicians and their medical office assistants (MOAs) designed to improve clinical and practice management and to support enhanced delivery of patient care.
Physicians who participate in the End of Life module learn how to identify patients who could benefit from a palliative approach to care; increase confidence and communication skills to enable advance care planning conversations; and improve collaboration with palliative care and non-palliative specialist services, patients, families, and caregivers.
“This module enables family doctors to add end-of-life planning to their regular practice of medicine,” says Jacobsen. “At the beginning of life, we do regular check-ups, and throughout a patient’s life we complete various checks. At puberty, we discuss sexual activity and do pap smears. At 50 we do a mammogram. The End of Life module creates a standard of care for people reaching that stage of their life, asking them how they want their care to unfold as they head toward the end of their lives.”
She believes this standard of care will become the family physician’s guideline for approaching the issue of death, instead of skirting around the issue. “This helps demystify and regularize the fact that we all die, that we should do it the way we each want.”
The module introduces physicians to forms and resources for patients that support them in making decisions and ensuring that these decisions are legally accepted. “It also helps improve my communication with other health care providers before a crisis develops,” notes Jacobsen. “I’m now more proactive in terms of getting the plan in place, the communications in place, the allied health care workers in place, and providing patients with peace of mind that they will be able to die on their own terms without losing their autonomy as they get closer to death.”
Her patients have been relieved to have their doctor broach the subject of death and advance care planning. Myrtle Haas, 79, had the end-of-life discussion with Jacobsen after dealing with the death of her sister. “After seeing what my sister went through, I was happy to talk about my plans,” says Haas. “It’s not fun to have that conversation. We’re not looking forward to the end of life, but we’re all going to get there. She was very caring and has a great sense of humour, which was helpful.”
Jacobsen says that once a physician has approached the topic with a patient, their families also find it a huge relief. “If the family doctor opens the subject, you remove the taboo of talking to family about it,” she says. “If you do it in a setting of an office visit, where critical illness isn’t right in front of you like in emergency or a hospital room, you’re much more likely to get a logical, thoughtful plan for the patient’s end of life.”
The PSP began as an initiative of the General Practice Services Committee (GPSC) – a joint committee of Doctors of BC and the BC Ministry of Health (the ministry) – and now receives additional direction, support, and funding from the Shared Care Committee and the Specialist Services Committee (also partnerships between Doctors of BC and the ministry).