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Ethics group unveils end-of-life initiative

By Dave Ranney | November 22, 2013

Sandy Silva, managing director of the "Transportable Physician Orders for Patient Preferences" campaign.

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The Center for Practical Bioethics today announced a campaign aimed at giving elderly and chronically ill patients more say in their end-of-life health care decisions.

The Transportable Physician Orders for Patient Preferences campaign — or TPOPP (pronounced Tee-Pop) — has been the subject of lengthy discussions among hospital, nursing home, and EMS officials in the Kansas City, Topeka, and Wichita areas for several months.

The discussions have focused on instituting policies and protocols that recognize a patient’s right to approve or refuse treatment — particularly regarding questions of resuscitation, preferred levels of care, and the use of feeding tubes to sustain life.

“We’re doing this because as people near the end of their lives it becomes increasingly important that they have the opportunity to be able to marry their values and desires for treatment (with) their decisions — whatever they may be,” said Sandy Silva, the campaign’s managing director. “TPOPP will give form to that. It will let patients have that conversation with members of their care team and let them have their wishes and decisions converted to a physician’s order.”

For example, she said, it’s not unusual for healthy patients to tell family members that they would want someone to perform CPR to save their life — but patient preferences tend to change once they become chronically or terminally ill.

With TPOPP, these changes would be documented, Silva said.

“When you talk to healthy adults about CPR, they think about it and say, ‘Sure, sign me up,’” she said. “That’s because CPR is successful 66 percent of the time — on television. But when you’re talking about someone who’s a long-term care resident or who has an advanced-stage chronic disease, it’s successful between 1 and 2 percent of the time."

“So if you’re that patient, is that what you really want?” Silva said.

Initiatives similar to TPOPP, she said, have been adopted or introduced in 44 states.

Eight hospitals in Kansas City area are moving toward TPOPP:

  • Liberty Hospital,
  • Heartland Health,
  • Olathe Regional Medical Center,
  • Overland Park Regional Medical Center
  • Saint Luke’s Hospital (Plaza),
  • Shawnee Mission Medical Center,
  • Truman Medical Center, and
  • University of Kansas Hospital.

The hospitals in Wichita — Wesley Medical Center and Via Christi Health — have embraced the initiative. The Medical Society of Sedgwick County has as well.

“The plan is to roll it out in April of next year,” said Carolyn Harrison, a registered nurse and chair of the Wichita TPOPP Steering Committee. “We’re working on educating the physicians on how to use the (TPOPP) form; we’re talking to case managers; we’re talking to everybody. It just takes time.”

Harrison, who teaches classes on advance directives, said TPOPP should not be confused with living wills or durable-power-of-attorney forms. “All of those are very important,” she said. “But they are not specific enough in many end-of-life situations, situations in which family members really don’t know what the patient who, for example, has been in an out of the hospital five times already, really wants to have happen.

“This isn’t about telling patients what to do,” she said. “It’s about promoting communication, and making sure patients have a say in what happens, and making sure that their desires are honored in the doctor’s order.”

A patient’s TPOPP orders, Harrison said, would be “valid” in all levels of care. “In the hospital, in the long-term care facility, in the emergency vehicle, in the home…it wouldn’t matter.”

The Center for Practical Bioethics is a nonprofit, free-standing and independent organization dedicated to advancing ethical practices and policies on health and healthcare issues. It’s supported by the Prime Health Foundation, William T. Kemper Foundation, Sunflower Foundation and Blue Cross Blue Shield of Kansas City.

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