Advance Care Planning Initiative
On this page
- Where are we now in B.C.?
- Stakeholder engagement in planning
- Highlights of accomplishments:
In December 2014 the BC Centre for Palliative care received funding from the BC Ministry of Health to lead and coordinate the planning and implementation of a province-wide initiative to address gaps in uptake of Advance Care Planning in BC.
The purpose of the provincial initiative is to work with partners within the health system as well as in the community to promote and facilitate integration of Advance Care Planning in all care settings using best-practices. In addition to the activities that support the integration of Advance Care Planning within the health system, the initiative employs a community engagement approach to drive and maximise the use of resources and expertise that already exist in the community in delivering sustainable public awareness activities and creating supportive environments for Advance Care Planning.
Where are we now in B.C?
In September 2016, we commissioned a public opinion poll to ask British Columbians about their level of engagement in Advance Care Planning. The poll results confirmed the low level of public awareness and engagement, especially among men and younger adults. Less than a third of respondents have heard of the term Advance Care Planning even when provided with a description of it.
Stakeholder Engagement in Planning
The initiative plan was co-designed with approximately 45 key stakeholders from across BC, including representation from all regional health authorities, the Ministry of Health, health-care professionals, a wide variety of provincial and local community and professional organisations, and representatives of the public.
The stakeholders reached a consensus agreement on three key activities for the Initiative to focus on:
- Public awareness and education
- Health-care provider education and training
- Integration and improvement of Advance Care Planning practices within the health system
The activities were linked to current Advance Care Planning initiatives in the province to foster coordination of efforts and cross-learning.
For illustrations of the initiative’s gaps/barriers, activities, outputs and outcomes see the Advance Care Planning Infographic and Logic Model.
Highlights of Accomplishments
Public awareness and education
Communities empowered to promote Advance Care Planning
In collaboration with two community organizations known for their public Advance Care Planning education, we developed a training curriculum and toolkit for community volunteers and organisations to facilitate and host Advance Care Planning sessions for the public. The aim is to upstream and normalize Advance Care Planning conversations in the community.
By the end of 2017, over 100 people have been trained to facilitate public sessions on Advance Care Planning, and over 880 members of the public have attended these sessions throughout BC.
Normalizing conversations in the community
Through our Seed Grants program, we engaged, funded and supported BC community organizations to implement 35 potentially sustainable and scalable projects that aim to:
- normalize and facilitate Advance Care Planning conversations among the public; and
- provide the public with information, tools and resources that can help them with their personal Advance Care Planning.
Provincial awareness of Advance Care Planning
Every year on April 16th, for National Advance Care Planning day, we coordinate with community organizations from across BC to widely promote Advance Care Planning in local communities. We have also promoted Advance Care Planning through related awareness days, including What Matters To you Day and Change Day BC.
User-friendly Advance Care Planning tools for the public
We prepared a more user-friendly version of the My Voice Guide and updated its content to align with the new definition of Advance Care Planning that was published in the past few years. The revised version of My Voice Guide is currently under review by key stakeholders and will be tested through focus groups of potential users.
Health-care provider education
Building a network of master trainers
We sponsored the training of eight health-care providers from different specialities at Ariadne Labs in Harvard University as master trainers so that they can educate other health-care providers on the use and integration of the Serious Illness Conversation Guide into patient care.
Two stakeholder engagement and consultation events were hosted in November 2016 by BC Centre for Palliative Care to introduce the Serious Illness Conversation Guide to health-care providers from across BC. Dr Rachelle Bernacki, from the Ariadne Labs attended and facilitated the two events. On the same day, we hosted a roundtable with over 60 representatives of health-system partners and stakeholders from across BC to discuss their interest and readiness to adopt the Serious Illness Conversation Guide in their organizations.
Roll-out of Serious Illness Conversation initiative
Based on the recommendations from the roundtable consultation, the health-care provider education component of the Advance Care Planning Initiative was rolled out as a separate initiative, named the Serious Illness Conversations initiative.
Integration and improvement of Advance Care Planning practices within the health system
We conducted a thorough review of the health authorities’ policies in the areas of Advance Care Planning, and the forms that they are using to document clinician’s orders after having advance care planning and goals of care conversations with the patient. The review report and recommendations for improved and consistent recording of patient wishes were submitted to the Ministry of Health.
Quality Indicators Recommendation
We reviewed potential indicators that could be used to monitor practices in relation to Advance Care Planning and alignment of provided care with patient wishes. We conducted a survey of the health authorities about the acceptability, feasibility, and readiness to adapt the identified indicators. Some of these indicators are currently being used in other provinces. The survey results and recommendations for a feasible set of quality indicators for Advance Care Planning were shared with the Ministry of Health.