"You have to be willing to talk about death." - Advance Care Planning (Geriatric Series Part I)

In our first episode of the Geriatric series, Dr. Xu and Drs. Ouellets discuss how to have difficult topics with patients involving death and loss of function. Darius facilitates the conversation with a beautiful couple facing these existential questions.

=== Outline ===

Chapter 1: Introduction to Advance Care Planning

Chapter 2: Discussing Difficult Topics

Chapter 3: Who’s in the room? Stakeholders

Chapter 4: Key Elemaents of an Advance Care Plan

=== Learning Points ===

1. We can define advance care planning in 1 of 2 ways: as a form of legal document or contract, or as an ongoing conversation about a patient’s values that will be revisited over the course of a patient’s lifetime. 
2. Another way of approaching the topic of ACP is in framing it as building a team who will be able to best support the patient through a difficult time: this could include family members, home health aides, financial planners, and so on. The most important member of this team to identify is the healthcare proxy: this person is designated to assist in making decisions should the patient be unable to.
3. Discussing ACP is applicable in any care setting: on the floors, in the ICU, and in the clinic. In the clinic, we have the benefit of time and a longitudinal relationship to keep on revising this topic--since a patient’s goals and priorities may shift over time, and the interventions they may desire will also shift accordingly.

=== Our Expert(s) ===

Dr. Gregory Ouellet graduated from Brown University in Providence, RI with a Bachelor of Science in biology and then attended medical school at the University of Rochester. He completed his clinical training in Internal Medicine and Geriatrics at Yale. He concomitantly completed a postdoctoral fellowship in Geriatric Epidemiology and Aging-Related Research and a Master in Health Science degree in 2018. Dr. Ouellet subsequently joined the full time faculty in the Section of Geriatrics. 

Dr. Jennifer Ouellet is a geriatrician who specializes in the care of older adults with multiple chronic illnesses.

=== References ===

1. Sudore RL, Fried TR. Redefining the "planning" in advance care planning: preparing for end-of-life decision making. Ann Intern Med. 2010 Aug 17;153(4):256-61. doi: 10.7326/0003-4819-153-4-201008170-00008. PMID: 20713793; PMCID: PMC2935810.
2. Sudore RL, Lum HD, You JJ, Hanson LC, Meier DE, Pantilat SZ, Matlock DD, Rietjens JAC, Korfage IJ, Ritchie CS, Kutner JS, Teno JM, Thomas J, McMahan RD, Heyland DK. Defining Advance Care Planning for Adults: A Consensus Definition From a Multidisciplinary Delphi Panel. J Pain Symptom Manage. 2017 May;53(5):821-832.e1. doi: 10.1016/j.jpainsymman.2016.12.331. Epub 2017 Jan 3. PMID: 28062339; PMCID: PMC5728651.
3. Fried TR, Bradley EH. What matters to seriously ill older persons making end-of-life treatment decisions?: A qualitative study. J Palliat Med. 2003 Apr;6(2):237-44. doi: 10.1089/109662103764978489. PMID: 12854940.

=== About Us ===

The Primary Care Pearls (PCP) Podcast is created in collaboration with faculty, residents, and students from the Department of Internal Medicine at the Yale School of Medicine. The project aims to create accessible and informative podcasts about core primary care topics centered around real patient stories. 

Hosts: Helen Cai

Producers: Helen Cai, Josh Onyango

Logo and Name: Eva Zimmerman

Theme music and Editing: Helen Cai, Josh Onyango

Other background music: Noir Et Blanc Vie, Asher Fulero, Astron, The Tides

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