Decisions project to hold national conference

Decisions Near the End of Life is a national ethics and organizational change training program for health facilities, offered by the Education Development Center (EDC) of Newton, MA, in cooperation with the Hastings Center, the American Medical Association, the American Hospital Association, and the American Bar Association. The next Decisions national leadership conference is scheduled for Oct. 7-9 in Albuquerque, NM, and EDC is encouraging hospices to consider signing up.

The program, which is based on research into how organizations change and the barriers to open and effective communication, brings together leadership teams from health care institutions, who learn how to implement a detailed set of educational modules back at home and to facilitate meaningful institutional improvement. The program also provides numerous opportunities to tackle ethical dilemmas in a safe environment for exploration with colleagues, says Decisions Program Director Karen Heller, PhD. The agenda includes two "grand rounds" sessions on legal issues and clinicians' attitudes on end-of-life issues and five training modules: planning with patients, weighing benefits and burdens, patients without decision-making capacity, problem solving in hard cases, and futility.

To date, 225 health facilities in 33 states have participated, most of them hospitals, although one hospice has also gone through the process. Each participating institution sends a "high-level, multidisciplinary team of three or more formal or informal leaders," and pays a fee of $3,200. "Any institution or agency providing care to adult patients near the end of life and their families is appropriate, if it thinks the program will benefit its staff and patients, and if it has sufficient resources" and commitment to follow-through on implementation, Heller says. "This may be hard for smaller agencies, but health systems may include a representative from an affiliated or owned hospice or home health agency. We encourage hospices to bring the program to the attention of their referring physicians or institutions, and to try to get a joint team to come."

Sources contacted by Hospice Management Advisor report that the Decisions program is well-respected in bioethics circles, although some hospice professionals may believe it teaches what hospices already know. Heller responds, "Hospice care providers are highly skilled in the clinical aspects of care at the end of life, but they may not be as equipped to deal with some of the ethical issues that may arise. . . . We have found in our presentations that hospice staff are as hungry as providers from other settings for guidance in considering the ethical issues and dimensions of the care they provide."

For more information on the Decisions program or the Albuquerque conference, contact Karen Heller at EDC, 55 Chapel St., Newton, MA 02158. Telephone: (617) 969-7100, ext. 2343. Web site: