The uncertainty surrounding the COVID-19 pandemic has made it even more imperative that physicians and other health care professionals talk about advanced directives.
Local and national advocates say now is an important time to have those difficult discussions with patients.
“The medical status of individuals with COVID-19, even those with seemingly benign and mild symptoms, can quickly change to the point that they may need advanced life support (e.g., a ventilator),” the U.S. Department of Health & Human Services wrote in a document created in April to assist physicians in talking with patients about advanced directives during the pandemic.
“Given all the ways that COVID-19 is affecting how medical care is provided, it is important to talk to everyone – in or out of hospital settings – about advance directives.”
This is certainly at top of mind with the folks at Wichita’s TPOPP, or Transportable Physician Orders for Patient Preferences. TPOPP Wichita – an initiative of the Medical Society of Sedgwick County in collaboration with both hospital systems – encourages, educates and promotes physician communication about end-of-life care for appropriate patients.
TPOPP Steering Committee chairwoman Carolyn Harrison said COVID has caused more people to stop and think about planning. It is a prime opportunity for physicians – whether in a clinic or hospital setting – to speak with patients about who has control of their medical decisions.
“We all need to practice more how to do serious illness conversations,” Harrison said. “For a physician, it may be different to predict what will happen with an illness, especially with COVID these days. We all need to work at that.”
The end-of-life discussion from a physician or health care worker standpoint generally revolves around ascertaining the values, goals and desires of patients so they receive the kind of care they want should they be unable to communicate about it themselves. A TPOPP form is a physician order designed for people with chronic, advanced illness or terminal illness. It’s not needed by everyone but may be appropriate for some high-risk patients during the COVID pandemic. Patients take those forms with them into clinical settings.
The conversation may not be as difficult as some imagine. Interest in advance directives has skyrocketed this year as COVID took hold. The Wichita Medical Research & Education Foundation, which houses all the Kansas advance directive forms – including TPOPP, Durable Power of Attorney for Health Care Decisions, Living Wills and DNRs – has seen at least a 30% increase in downloads from its website since March 15, and a significant uptick in hospitals and clinics requesting forms. New Spanish versions have been downloaded 1,400 times since March.
“One of the biggest things from COVID is that it has spurred the conversation,” executive director Peggy Johnson said.
TPOPP focuses on communication between the patient or their surrogate (legally designated decision-maker) and the patient’s physician or health care providers that ensures informed medical decision-making occurs, organization officials said.
“It’s about trying to figure out what the patient wants or doesn’t want and letting health care professionals have access,” said retired family physician Barbara Coats, MD, also part of the TPOPP steering committee. “We need to have those conversations.”
Resources available to help physicians facilitate serious illness discussions …
- Ariadne Labs’ Serious Illness Conversation Guide offers clinicians language to ask patients about their tinyurl.com/MSSC-ALGuide
- Using REMAP to talk to patients, from HHS: tinyurl.com/MSSC-remap
- More about TPOPP Wichita: tpoppwichita.com
- Kansas advance directives forms: tinyurl.com/MSSC-WMREF