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Published on October 13, 2015

Talking about the end of life—before it’s too late

Talking about the end of life—before it’s too late

Death might be the toughest conversation of all.

What are your hopes for the last years of life? Have your shared your final wishes with family members and your doctors? What is your vision of what life might look like in your final days, weeks or months?

While we might be able to stutter and stumble our way through chats about love or money, most of us balk when it comes to talking about death.

By the time you’re at someone’s bedside—or your family is at yours—it may be too late.

Getting that important but difficult conversation started is the idea behind Cape Cod Healthcare’s first Quality of Life Management Summit. The free, daylong event was held Wednesday, Oct. 14, at the Cape Codder Resort in Hyannis.

It’s time to start talking, said Donald Guadagnoli, MD, senior vice president and chief medical officer at Cape Cod Healthcare, who worked with colleagues to organize the conference.

“It’s our job to follow your wishes and to know what your wishes are,” said Dr. Guadagnoli said about the medical community. “But quite often people haven’t thought about that or had that discussion.”

The summit, he said, will help to get the conversation rolling. “We need to back up 15 steps when people are healthy enough to have the conversation.”

The summit is organized in two parts: Speakers in the morning sessions will lay out the problems, and afternoon workshops will explore solutions.

Daniel Hoefer. MD, the chief medical officer for outpatient, palliative and hospice care at Sharp HealthCare in San Diego, will be the summit’s keynote speaker. Sharp runs a model “transitions” program at its seven acute care hospitals.

Program staff work with chronically and terminally ill patients and their families to understand the available care options and create a plan, Dr. Guadagnoli said .

Guadagnoli will speak at the summit and be joined by Cape Cod Healthcare colleagues Elissa Thompson, MD, RPVI, a cardiologist, and Devin McManus, MD, medical director of JML Care Center in Falmouth..

Speakers in the morning session will talk about why patients and families need to have a realistic idea of the end of life, whether that decision must be made quickly or considered with a progressive chronic illness.

The “community track” in the afternoon will focus on tools families and others can use to talk about end-of-life care. Examples include the Five Wishes, a list developed by the nonprofit Aging with Dignity 20 years ago, and Massachusetts Orders for Life Sustaining Treatment Program, or MOLST, the state’s standardized medical order form for providers caring for patients with serious illnesses.

The afternoon’s “provider track” will feature more about the Sharp model and information about chronic and palliative care on the Cape.

Cape Cod is a good place to start a community conversation about life with a chronic progressive illness and dying, Dr. Guadagnoli said. Almost 28 percent of the population is over 65, which is twice the national average.

Families and physicians too often dodge the issue when everyone is still feeling well. And even patients who have a healthcare proxy appointing a family member to make decisions, may not have made it clear what those decisions should be.

“How can we mobilize as a community to train people to have these discussions and then put together other discussions in libraries, attorney’s offices, churches, skilled nursing facilities?” Dr. Guadagnoli asked. “We need to have people from across the community come together to try to figure out how to make this better.”