Talking About The End of Life
Mid Coast Health Services
Most Americans say that when the end comes, they want to die at home, rather than in a hospital’s intensive
care unit. But the fact is that most people do die in a hospital. And their final days are often marked with
intensive, invasive and costly treatments—treatments that fail to improve the quality of patients’ last days.
This disconnect between what patients want and what care they actually receive is something that Mid Coast
Health Services in Brunswick is addressing throughout its system. Over the past year, Mid Coast has worked to
implement a system-wide, integrated approach to improve access to advance care planning, palliative care and
end-of-life care.
The effort was inspired by the health system’s patient advisory council.
“Their number one focus was end-of-life care,” said Darlene Chalmers, RN, MS, vice president of elder and
home care services. Patients haven’t had the kinds of choices they wanted as they approached their final days,
she added.
Physicians in particular, and the healthcare system in general, usually focus on cures. But as many illnesses
progress, there comes a point when the focus has to shift from curing patients to making them as comfortable
as possible. That kind of care is called palliative care. It focuses on the quality of a patient’s days, not the
quantity. The problem is that caregivers sometimes have trouble shifting the conversation with their patients
from cure to comfort.
“It’s not easy for providers,” Chalmers said.
Mid Coast is giving all its healthcare providers the tools to have those conversations with their patients to find
out what’s important for each person. They are providing system-wide education on Advance Care Planning
and Physician Order for Life-Sustaining Treatment (POLST). As of April, 82 percent of the system’s providers
had viewed a one-hour video, “Critical Conversations,” to help teach them how to talk to their patients about
end-of-life care. Mid Coast is affiliated with MaineHealth, which worked with them to disseminate the video
and other aspects of the initiative.
"Everybody should have (an advance directive)
document. You never know."
Mid Coast Health Services
