Providence incents employees to make end-of-life care plans

ORLANDO, Fla. — Executives from Providence Health & Services said that the Renton, Wash.-based Catholic health system's recent initiative to encourage all its employees to draft their own advanced care directives was intended to serve the dual purpose of promoting employee well-being and making caregivers less fearful of broaching the subject of end-of-life care preferences with their patients.

At an Innovation Forum on Sunday, June 5, the opening day of the Catholic Health Assembly here, Dr. Ira Byock, chief medical officer of the Providence Institute for Human Caring, and Keegan Fisher, Providence Health & Services senior director of benefits, explained that Providence incorporated the advance care planning activity into last fall's open enrollment process for employee health care benefits. The system tied its contribution to the employees' health benefit to completion of the educational exercise on advance care directives, offering either a deposit into the health savings account of a family or individual or else a premium credit as an incentive.

More than 93 percent of the system's 5,200 employees in five states completed the incentive program by watching an educational video on advance care planning, answering eight reflective questions on the subject and committing to a goal for their own advance care plan.

Keegan and Byock said employees were very appreciate of the push to formalize their end-of-life care wishes. Doing so, Byock said, is a great kindness to family members who may be required to make care decisions for a loved one who is beyond communicating his or her care preferences.

Byock pointed to research at Dana-Farber Cancer Institute in Boston that showed terminally ill patients who had had a conversation with their doctor about end-of-life care at some time during their illness were much less likely to be admitted to an intensive care unit in their last week of life, be placed on mechanical ventilation or undergo cardiac pulmonary resuscitation.